A new paper by University of Calgary psychologist Dr. David Hodgins says the proliferation of gambling opportunities around the world, particularly online, is increasing the visibility of gambling disorders and giving access to people who previously had no exposure to gambling opportunities.
Hodgins, head of the university's Addictive Behaviours Laboratory, says gambling disorders are often found in conjunction with other mental health and substance-abuse disorders. In an online version of the medical journal, The Lancet, Hodgins says the study of problem gambling is relatively recent and further understanding is needed to find root causes and treatment implications.
"Most of our progress in recognizing and understanding gambling disorders has been made in the past 25 years," says Hodgins. "Our knowledge continues to evolve in parallel with a burgeoning availability of gambling opportunities. Internet gambling, for example, is providing around-the-clock home access to several types of gambling activities to an increasing number of people around the world."
The prevalence of gambling disorders worldwide is highly variable, ranging from 1 in 500 people in Norway to as high as 1 in 20 people in Hong Kong. In the USA, about one per cent of the population are pathological gamblers, with a further one to two per cent categorized as problem gamblers.
Gambling problems are often accompanied by other conditions. Pathological gamblers have a four-times increased risk of alcohol abuse and up to six-times increased risk of drug abuse; and also a four-times increased risk of having some kind of mood disorder.
Research suggests that a number of centres in the brain are implicit in gambling disorders, including learning and reward centres. Genetic factors also play a part, with evidence from twin studies suggesting some level of shared risk between identical twins. And environmental factors are clearly part of the risk, including accessibility to gambling, location and type of establishment. Childhood exposure to gambling through parents with a gambling addiction of some level also affects gambling behavior later in life.
Due mainly to shame, denial, and a desire to handle the problem themselves, only one in 10 problem gamblers seeks treatment. Surveys suggest around a third of problem gamblers recover during their lifetime, and that the disorder is transient and episodic in many cases. Many gamblers chose to self-help by doing time-consuming activities incompatible with gambling, and avoiding gambling venues and exposure to temptations.
For those who do seek treatment, cognitive behavioural therapy has proven to be about 60 per cent more effective then no treatment at all. This focuses on modifying distorted perceptions associated with gambling, including overestimating probabilities of winning, illusions of control over the outcome of a gamble, the belief that a win is due after a series of losses (the gambler's fallacy), and memory biases in favour of remembering wins.
No drugs are currently approved anywhere for treatment of gambling disorders, however there have been numerous trials. Testing of drugs used mainly in alcohol and heroin addiction have been show to help reduce the intensity of gambling urges, thoughts and behaviour.
Other interventions, such as Gamblers Anonymous, promote a sense of common purpose and understanding to reinforce abstinence. However, some studies have suggested that adherence to such sessions, can be poor, as can the outcomes. Family therapy, in which close family members are helped to give interventions to their loves ones, can have positive effects but can also be difficult to administer without the direct help of a therapist.
"While substantial progress has already been made, the increased visibility and awareness into gambling disorders is likely to encourage more innovative research in the field and hopefully better treatment," says Hodgins.
- David C. Hodgins, Jonathan N. Stea, Jon E. Grant. Gambling disorders. The Lancet, 2011; DOI: 10.1016/S0140-6736(10)62185-X
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