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Gambling addiction - Cause, outcome and a way out
From Dr. Thorsten Heedt, medical specialist for psychotherapy with an emphasis on the treatment of post-traumatic illnesses.
All addictions have one thing in common whether you are addicted to alcohol, heroin and nicotine or to gambling:
- The addictive "drug" is consumed obsessively in the course of the addiction even though the feeling of joy might not be achieved by consuming the "drug".
- The loss of control increases steadily.
- The addictive drug is used to flee from reality.
- The addiction continues even though it has caused several negative consequences or health damage.
The following article deals with addiction to gambling, its origin and how to determine whether you are suffering from a gambling addiction and where you can find help.
2. What is gambling addiction?
Pathological playing is listed under "abnormal behavior or flaw in the control of the impulses" in the ICD-10 of the established international illnesses classification and is defined as follows:"The malfunction consists of frequent and repeated gambling, which controls the life of the patient and leads to the breakup of social, occupational and family values and commitments."
Excessive playing by manic patients is defined as: A mania is a discrete disease which goes along with strong arousal, inner agitated melancholia, positive changes in mood without reason, and a ceaselessly agitated melancholy.
Also deferred from the gambling addiction is playing with a social personality disorder characterized by a disregard for social obligations and heartless disregard for feelings of others. This type of behavior can be found quite frequently in prisons.
Pathological playing is characterized by persistent, recurrent and often increased gambling behavior despite negative personal and social consequences such as debt, disruption of family relationships and effects on one's professional development.
Before one can be said to suffer from pathological playing, there have to be two or more episodes of pathological playing over a period of at least one year.
The distorted thinking patterns of gamblers are also mentioned in another widespread disease classification, the "DSM-IV":
- The special importance of money for gamblers.
- Thinking patterns concerning competition.
- The restlessness of a gambler.
- Their exaggerated need for social recognition.
- A tendency for work mania.
- The frequent occurrence of psychosomatic stress disorders.
3. How does a gambling addiction develop?
3.1. The basic problem
The development of a gambling addiction is a complex process affected by several factors. The most important factors are the following:
- A profound disturbance of one's self-worth ("narcissistic" disorder).
- A relationship disorder.
- Irregular arousal.
The serious underlying self-esteem disorder is of particular importance where the self is described as an emptiness or as nothing. Several deep-rooted feelings of inferiority, originated from the childhood, are compensated for by delusions of megalomania.
The initial winnings strengthen the ego and confirm that we are indeed something special. In the beginning, there is often a "big win", an apparent rapid and easy profit which marks the start for taking off into a fantasy world.
The British child psychiatrist John Bowlby created the bonding theory in the 60s. He noted that depending on the sensitivity of the mother to the baby various bonding types are created:
The inability to adequately regulate the internal tension and excitement results in the particular restlessness of a gambler. The motivation for playing in the beginning is often the quest for success and profits, the reduction of boredom or managing negative emotions such as occur after a separation. The player gradually falls into a vicious circle, which all other areas of his life fall victim to.
The gambler is finally distinguishable through his reduced impulse control, which is the impulse to play that cannot be resisted. This behavior is similar to alcoholics who can't resist drinking again straight after being released. Despite the many negative consequences, the desire to relieve tension by playing is strengthened.It has a neurological basis as well. The reward system of the brain is chronically overstressed which leads to a counter-regulation of the brain. In order to protect against harmful agitation of the brain, it starts to react less to the reward stimulus. A neurological adaptation starts to set in. In order to get the desired kick, buy-ins or the volume of play have to be increased. By the way, the most conductive situation to this addiction is the showdown.
3.2. Distorted thinking patterns
Typical for gamblers are many distorted irrational attitudes:
- The illusion of control
This is shaped by the assumption that gambling has more personal influence than is the case objectively.
They say that profits are due to their ability and losses due to unfortunate circumstances.
- The Monte-Carlo effect ("gamblers fallacy")
The frequency of past events suggest what the probability of future events is going to be (e.g. at roulette: There were 3 black numbers in a row, this must mean that the probability of red is increasing.)
- Misinterpretation of the probability of winning
The player over estimates his profit prospects unrealistically. For example, 98% of all raffle buy-ins are lost.
- The near-hits ("cognitive regret and near miss")
This occurs in gambling machines where three of the same symbols have to appear in order to receive a payoff but you only get 2 of the same symbols. The result: "I just missed winning, so I have to continue playing!"
- The capture ("entrapment")
This is the adherence to wrong decisions to justify the investments already made - "Ok, I'm probably beat, but since I called until the turn I am going to look at the river as well."
There is evidence that a very high percentage of faulty thought patterns are created while gambling.
4. Who is at risk?
The people most affected are males who live alone in a large city around the age of 30. The onset of addiction usually occurs in adolescence, however, women tend to become addicted in the middle stages of their lives. If they enter treatment, they are usually already deeply in debt, in danger of suicide and usually have committed crimes in order to raise funds for playing. A large proportion (approximately one third) of the addicts also suffer from physical dependencies, i.e. alcohol or heroin.
About 2-3 % of the population has a gambling problem and roughly 1 % suffer from what is called abnormal gambling behavior. There is a correlation between the availability of gambling on offer (for example, measured as slot machines per 1000 inhabitants) and the frequency of pathological gamblers.
Triggers for addiction could be experiences of winning a lot ("a big win") or debilitating life experiences such as partnership problems, separation, pregnancy of one's partner or professional upheavals.The high morbidity (parallel existence of other diseases) is very noticeable. For example, up to 50% of all gambling addicts have depressive disorders, which are driven by compulsive disorders, depressed mood and loss of general interest.
25% of all gamblers who have sought treatment have already tried to commit suicide once. Particularly striking is the frequent occurrence of personality disorders which over 90% of treated gamblers have.
A personality disorder is characterized by a persistent distorted behavior pattern which begins in childhood and adolescence causing serious problems in social relations. The narcissistic personality disorder occurs especially often which is where one develops an overblown sense of one's own importance. For example many patients exaggerate their own achievements and talents, are self-absorbed about their fantasies, unlimited success, power, glamor, beauty or ideal love. They think of themselves as being very unique and they continually strive for excessive admiration.
This narcissistic personality disorder is difficult to treat because the patient tends to devalue the therapist or stop the treatment if he doesn't confirm his fantasized greatness.
5. What are the effects of a gambling addiction?
A dynamic develops, typical to this addiction, which affects all areas of life. Eventually these people have limited possibilities to regulate their actions.
The dynamic of the addiction shows, for example, when people try to offset their losses by increasing their buy-ins, so-called chasing. In poker, this is referred to as going on tilt.
Social isolation gradually increases. Feelings of shame and guilt start to set in and people start to conceal their gambling. Players increasingly integrate themselves into a specific environment with a lifestyle typical to gamblers, a lifestyle based on the immediate gratification of the player's needs. This can lead to criminal acts in order to obtain funds for gambling.
Finally, players can get ruined financially, lose the support of their families or lose their jobs. Psychiatry visits due to suicide attempts may follow, some gambling addicts go on to become criminals.
The effects of constant ceaseless gambling can manifest physically. For example, through symptoms like peptic ulcers, headaches or heart attacks.
6. How do I know whether I am addicted?
There are a number of questionnaires and testing procedures to test whether a gambling addiction is present and to delineate pathological gambling from other forms of gambling like social gambling, professional gambling, gambling in a manic episode, gambling with an antisocial personality or pathological pc-usage (gaming, chatting, surfing).
The world's most widespread scale is the SOGS (South Oaks Gambling Screen). There are many other testing procedures as well though. Finally, they all basically test the same thing, namely whether you have the ability to control your urge to play and to quit playing if there are negative consequences to playing, i.e. exhaustion. They also test whether the narcissistic problems mentioned in the chapters above, are present, whether problems such as debt are present and whether the player is willing to carry out criminal acts in order to obtain funds.
To assess whether you might be addicted to gambling, you can take the following test. It is a questionnaire with 19 questions that you either answer with yes or no. If you answer more than 7 questions with yes, gambling addiction might be a problem for you.
1. Have you ever played until all your money was gone?
2. Have you ever borrowed funds for gambling?
3. Have you ever taken a loan because of or for gambling?
4. Do you regularly go over the time or financial limit which you set for yourself, gambling?
5. Have you ever thought about obtaining money by doing illegal things?
6. Do you think a lot about gambling?
7. Have you ever stolen money for gambling?
8. Do you have a hard time focusing on other things except gambling?
9. Are you anxious or aggressive if you can't play?10. Does your normal life seem boring compared to the gambling?
11. Does your interest for your social life decrease?
12. Do you play to recoup losses?
13. Do you hide how much you are playing and how much you have lost from your family?
14. Do you often have a guilty conscience after you've played?
15. Has it happened that you continued playing even though you knew that you would hurt yourself or others?
16. Have you ever played in order to improve your mood and to avoid problems?
17. Has the gambling caused fights or disputes in your family?
18. Have you ever missed school or work in order to play?
19. Have you ever thought about or actually tried to commit suicide due to your gambling problem?
8. What to do about gambling?
We have to determine at first whether we are dealing with a gambling pattern that has a pathological value. You should turn to a specialized advisory board (see also: search on this website)Then you have to decide between outpatient and inpatient treatment. If the patient is still well integrated socially, when the addiction hasn't had a chance to develop that much yet, a visit to an addiction counseling center or outpatient psychotherapy with an established psychological or medical psychotherapist is advisable.
If the addiction has advanced pretty far, one must decide whether the patient should be taken to a psychosomatic specialist clinic or an addiction clinic. If the psychosocial consequences aren't that serious yet or if the gambling behavior was only caused by acute stress situations (such as separation, loss of the job etc.) it would be advisable to make use of a psychosomatic specialist clinic for treatment.
In an advanced addiction dynamic, a specialist clinic for addiction should be chosen. If there is also a physical addiction to some drugs, i.e. alcoholism or drug abuse, the person should be weaned from the drugs in a psychiatric clinic.
In general, this is the part of therapy where both parties make a contractual agreement on compliance with gambling abstinence. A simple reduction of gambling is usually not enough. In particular, complete abstinence from the drug usually reveals the underlying problem that usually manifests itself quite clearly, which is the actual cause of the patient needing the addictive drug in the first place.
It is important in any case, to find the real reason behind the gambling behavior, and then to talk about making changes in the typically distorted thinking patterns and to work out a plan for relapse prevention with the patient in the treatment. All of the problems of the gambler have to be worked on i.e. the disturbance of self-regulation, emotional regulation, and the relationship patterns. Distortions in these relationship patterns can be worked on quite well in group therapy.
It is of particular importance to highlight the debt problem in order to create a debt management program for the patient rather than to ignore this problem. The relatives should normally be involved, as they usually end up support the patient with his pathological problem by accepting the debt.
9. Where can I find help?
On this website there are detailed descriptions of problem gambling which might help you with your problem. There are lots of other websites listed in the references which might also be of interest. Furthermore you could call the following hotline to get some professional advice:1-800-522-4700
You'll be anonymous. Relatives can also call this number.
Click for more information.