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Compulsive Gambling

Introduction
Signs and symptoms
Causes
Risk Factors
Screening and diagnosis
Treatment
Prevention

Gambling odds, as the saying goes, are stacked in favor of the house. But that doesn't stop people from trying to beat the odds and hit the jackpot. About 85 percent of American adults say they have gambled at some point in their lives, whether it's at the racetrack, the casino or online. Gambling results in hundreds of billions of dollars in annual wagers. And for some people, it also results in compulsive gambling, or an urgent need to keep gambling despite the toll it exacts on their lives.

People with compulsive gambling lose control of their betting behavior, often with serious consequences. They're constantly chasing their losses, and they often go to extremes to hide their gambling. They may even resort to fraud or theft when faced with desperate financial problems.

Rather than being an addiction, compulsive gambling is technically classified as an impulse-control disorder - a disorder in which you can't resist a temptation or drive to perform an act that's harmful to you or someone else. Whatever the label, it's difficult to overcome the powerful hook of compulsive gambling without professional treatment.

People with compulsive gambling are typically in it for the thrill, rather than the actual winnings. They find the action exciting and arousing.

Signs and symptoms of compulsive gambling include:

• A preoccupation with gambling
• Reliving past gambling experiences
• Taking time from work or family life to gamble
• Concealing gambling
• Feeling guilt or remorse after gambling
• Borrowing money or stealing to gamble
• Failed efforts to cut back on gambling
• Lying to hide gambling

People with compulsive gambling often wager money that they need to pay bills. When they lose, they chase their losses, or attempt to gain back the money they've gambled away. They may turn to gambling both when they feel down and when they feel up. If they try to cut down on gambling, they may become restless or irritable.

It's not known what drives people to engage in compulsive gambling. Problems with certain naturally occurring chemicals in the brain may play a role. In particular, the neurotransmitters serotonin, norepinephrine (noradrenaline) and dopamine may be factors.

Neurotransmitters act as chemical messengers that enable nerve cells (neurons) to communicate. Neurotransmitters are released into the gaps (synapses) between nerve cells in the brain to help messages flow from one cell to another. If neurons don't produce enough of these chemicals, messages aren't communicated effectively. Serotonin is a chemical in the brain that plays a key role in regulating mood and behavior.

Norepinephrine, a hormone released in response to stress, has been linked to arousal and risk-taking in compulsive gamblers. Brain cells release dopamine as part of the reward system through which you learn to seek things that make you feel pleasure, such as food and sex. Dopamine plays a role in developing addiction. Together, these may set the stage for compulsive gambling.

Most people who wager don't have a problem with compulsive gambling. But an estimated 2 million American adults do become compulsive gamblers at some point in their lifetimes. In males, compulsive gambling typically starts in adolescence, while it's later for females.

A number of factors increase your risk of developing compulsive gambling, including:

• Other behavior or mood disorders. People who gamble compulsively often have substance abuse problems as well as mood and personality disorders.
• Age. You may be more likely to develop an addiction to gambling if you begin to gamble at a young age.
• Gender. Men are more likely than are women to develop a gambling addiction.
• Location. People who live close to a casino or betting facility are more likely to develop a gambling problem than are those who live farther away.
• Family influence. If your parents had a gambling problem, the chances are greater that you will too.
• Medications used to treat Parkinson's disease. Medications called dopamine agonists, and in particular pramipexole (Mirapex), have a rare side effect that results in compulsive behavior in some people.
• Certain personality characteristics. Being highly competitive, a workaholic, restless or easily bored may increase your risk.

Mental health professional can diagnose compulsive gambling by evaluating mood and patterns of behavior. To be diagnosed with compulsive gambling, someone must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.

The DSM classifies compulsive gambling as a type of impulse-control disorder. This means that you're not able to resist the impulse or temptation to engage in behavior that'll harm you or someone else. Typically with impulse-control disorders, people feel a sense of emotional arousal or excitement before engaging in the behavior, followed by pleasure and gratification. However, that may quickly be followed by guilt or remorse.

For compulsive gambling to be diagnosed, at least five of the following signs and symptoms must be present:

• Being preoccupied with gambling, such as reliving past gambling experiences or planning ways to get gambling money
• Needing to gamble with increasing amounts of money to become excited
• Trying to cut back on gambling, without success
• Getting restless or irritable when attempting to cut down on gambling
• Gambling as a way to escape problems or to relieve feelings of helplessness or sadness
• Chasing losses, or trying to gamble back lost money
• Lying to family members, therapists or others to hide the extent of gambling
• Committing fraud, theft or other illegal acts for the sake of gambling
• Jeopardizing or losing an important relationship, job, or educational or career opportunity because of gambling
• Turning to others for money when the financial situation becomes desperate

Because excessive gambling could be an indication of a manic episode of bipolar disorder, your health professional will also evaluate you to see if that's what you have instead.

Treating compulsive gambling can be challenging. That's partly because for many people, it's hard to admit that compulsive gambling is a problem in their life. A major component of treatment is working on acknowledging that compulsive gambling is a problem for you. If you feel that you entered treatment under pressure from loved ones or your employer, you may find yourself resisting your treatment plans. But know that treatment can help you regain a sense of happiness and control - and perhaps even help heal damaged relationships or finances.

Treatment for compulsive gambling involves three main approaches. These are:

• Psychotherapy. A form of psychotherapy called cognitive behavior therapy (CBT) may be especially beneficial for compulsive gambling. CBT focuses on identifying unhealthy, irrational and negative beliefs and replacing them with healthy, positive ones. Group therapy also may be helpful. In group therapy, you're able to tap into the advice, feedback and support from other people facing similar issues.
• Medications. Several types of medications may help mood and emotional issues that often go along with compulsive gambling. Antidepressants and mood stabilizers are two types of medications often prescribed to help treat compulsive gambling. In addition, medications called narcotic antagonists, which have been found useful in treating substance abuse, may help treat compulsive gambling.
• Self-help groups. Some people find self-help groups such as Gamblers Anonymous a helpful part of treatment. Its recovery program is based on the acceptance of certain spiritual values, but it's not a religious organization.

Even with treatment, you may experience a relapse and return to compulsive gambling, especially if temptations are nearby. If you feel like returning to gambling, contact your health care professionals to head off a full-blown relapse.