CASE 349 - Gambling

Problem gambling (ludomania) is an urge to gamble despite harmful negative consequences or a desire to stop. Problem gambling often is defined by whether harm is experienced by the gambler or others, rather than by the gambler's behavior. Severe problem gambling may be diagnosed as clinical pathological gambling if the gambler meets certain criteria. Although the term gambling addiction is common in the recovery movement[1] pathological gambling is considered to be an impulse control disorder and is therefore not considered by the American Psychological Association to be an addiction.

Definition

Research by governments in Australia led to a universal definition for that country which appears to be the only research based definition not to use diagnostic criteria.
Problem gambling is characterized by many difficulties in limiting money and/or time spent on gambling which leads to adverse consequences for the gambler, others, or for the community.

Most other definitions of problem gambling can usually be simplified to any gambling that causes harm to the gambler or someone else in any way. However, these definitions are usually coupled with descriptions of the type of harm or the use of diagnostic criteria. According to DSM-IV, Pathological gambling is now defined as separate from a manic episode. Only when the gambling occurs independent of other impulsive, mood, or thought disorders is it considered its own diagnosis. In order to be diagnosed, an individual must have at least five of the following symptoms:



Preoccupation. The subject has frequent thoughts about gambling experiences, whether past, future, or fantasy.
Tolerance. As with drug tolerance, the subject requires larger or more frequent wagers to experience the same "rush".
Withdrawal. Restlessness or irritability associated with attempts to cease or reduce gambling.
Escape. The subject gambles to improve mood or escape problems.
Chasing. The subject tries to win back gambling losses with more gambling.
Lying. The subject tries to hide the extent of his or her gambling by lying to family, friends, or therapists.
Loss of control. The person has unsuccessfully attempted to reduce gambling.
Illegal acts. The person has broken the law in order to obtain gambling money or recover gambling losses. This may include acts of theft, embezzlement, fraud, or forgery.
Risked significant relationship. The person gambles despite risking or losing a relationship, job, or other significant opportunity.
Bailout. The person turns to family, friends, or another third party for financial assistance as a result of gambling.
As with many disorders, the DSM-IV definition of pathological gambling is widely accepted and used as a basis for research and clinical practice internationally.



Biological basis
According to the Illinois Institute for Addiction Recovery, recent evidence indicates that pathological gambling is an addiction similar to chemical addiction. It has been seen that some pathological gamblers have lower levels of norepinephrine than normal gamblers.
According to a logical study conducted by Alec Roy, M.D. formerly at the National Institute on Alcohol Abuse and Alcoholism, norepinephrine is secreted under stress, arousal, or thrill, so pathological gamblers gamble to make up for their under-dosage.
Further to this, according to a report from the Harvard Medical School Division on Addictions there was an experiment constructed where test subjects were presented with situations where they could win, lose or break even in a casino-like environment. Subjects' reactions were measured using fMRI, a neuro-imaging technique very similar to MRI. And according to Hans Breiter, MD, co-director of the motivation and Emotion Neuroscience Centre at the Massachusetts General Hospital, "Monetary reward in a gambling-like experiment produces brain activation very similar to that observed in a cocaine addict receiving an infusion of cocaine."
Deficiencies in serotonin might also contribute to compulsive behavior, including a gambling addictions.