Addiction has certain defining features – persistent engagement in a trait despite negative repercussions, reduced self-control over this engagement, a compulsion to engage in the behavior, and a strong craving for the activity (Yau & Potenza, 2015). For a long time, the term “addiction” has been linked to excessive drinking of alcohol or substance use (Yau & Potenza, 2015). However, scholars have begun to recognize that certain behaviors are similar to drug and alcohol dependence. These behavioral addictions include excessive involvement in activities such as gambling, video game playing, Internet use, eating, shopping, and sex. This paper will zero in on gambling addiction, also known as gambling disorder.
Disorder gambling is characterized by frequent thoughts about gambling, staking greater sums of money to receive a similar satisfaction, constant failure to stop or control gambling, discomfort when trying to quit gambling, and gambling infringing on other areas of one’s life (Yau & Potenza, 2015). This disorder also manifests when one gamble to escape a sad state, relies on others to fund their gambling nature, lies to others about their gambling activities, or gambles to recoup previous losses. The prevalence of disordered gambling in adults has been estimated to be between 0.1% to 2.7%. This figure appears to be higher among college students, 7.89% according to Nowak and Aloe (2013). Individuals with disordered gambling also tend to display other forms of addiction such as substance use. It also co-occurs with certain psychiatric conditions such as mood, personality, and anxiety disorders.
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Causes
Personality traits such as impulsivity, sensation-seeking, and a reduced tendency to avoid harm have been linked to substance and behavioral addictions, including gambling (Leeman & Potenza, 2011). Certain aspects of compulsivity are more present in persons with behavioral addictions. As such, behavioral addictions like gambling have been conceptualized along an impulsive-compulsive spectrum. Moreover, disordered gambling has been linked to neurocognitive measures of decision-making and disinhibition (Yau & Potenza, 2015). As such, people with gambling addiction tend to have impaired decision-making and reflection impulsivity. Such people tend to select smaller rewards that come immediately instead of waiting for bigger rewards that come later.
Certain neural mechanisms such as dysregulated serotonin functioning may lead to impulsivity and behavioral inhibition which characterize disordered gambling. Disordered gamblers also demonstrate reduced or increased activity in their ventromedial prefrontal cortex (vmPFC) as opposed to non-gamblers. Genetic factors also play a significant role in the development of disordered gambling with an estimated heritability of between 50-60% (Leeman & Potenza, 2011). This statistic is comparable to that of substance addictions. Genetic mutations linked to disordered gambling mainly affect dopamine and serotonin transmission.
Social Effects
Gambling addiction harms intimate relationships. The effects of gambling addiction on intimate relationships start with the denial phase when the individual makes excuses for gambling. During this period, the person also considers gambling temporary and the partner is easily reassured. This stage progresses into the stress phase when a spouse spends less time with family members. Arguments arise frequently and the partners often feel rejected. The gambler’s habits begin to place a financial burden on the family. The last stage, the exhaustion phase, is characterized by impaired thinking, confusion, anxiety, and panic. The couple begins to feel intense resentment for each other (Suomi et at. 2013).
Gambling addiction causes the family environment to become full of anger and conflict and a lack of communication and independence. Family members also become less involved in cultural and intellectual activities as well as social and recreational activities. Children of parents with gambling problems are exposed to emotional and financial deprivation, inconsistent discipline, physical isolation, poor role modeling, parental neglect, and reduced stability and security. Gambling addiction has also been associated with intimate partner violence (IPV). Individuals with gambling issues have a higher chance of being perpetrators or victims of IPV compared to those without gambling problems. This violence may be caused by gambling-related stressors such as mistrust, financial losses, and poor communication (Suomi et at. 2013).
Gambling disorder has a wide range of effects on the emotional, physical, and behavioral well-being of intimate partners and children. Intimate partners might experience emotional disturbances like depression, anxiety, and resentment while children will experience depression, anger, confusion, and hopelessness. Physically, intimate partners will complain of headaches, hypertension, and gastrointestinal issues while children will present with allergies, asthma, and chronic headaches. Moreover, intimate partners will experience behavioral difficulties like smoking, excessive drinking, and impulsive spending. In contrast, children might run away from home, perform illegal acts, perform poorly at school, or engage in substance abuse (Suomi et at. 2013).
Treatment
The treatment of gambling disorder can be divided into pharmacological and behavioral interventions. Pharmacological interventions include the administration of opioid receptor antagonists such as naltrexone and nalmefene (Yau & Potenza, 2015). These drugs have been used for decades to treat patients with alcohol addiction. They have recently proved to be effective for patients with behavioral addictions such as disordered gambling. The discontinuation of naltrexone has been associated with continued positive effects. The first drugs to be used to treat disordered gambling were selective serotonin reuptake inhibitors (SSRIs) (Yau & Potenza, 2015). However, clinical trials of their efficacy have delivered mixed results.
Cognitive-behavioral therapy (CBT), a behavioral intervention, is effective in randomized trials. CBT seeks to challenge the illogical thoughts and beliefs that are thought to add fire to compulsive behaviors (Yau & Potenza, 2015). As such, it trains patients to implement strategies and skills aimed at changing these patterns and disrupting addictive behaviors. A series of alternative behaviors and goal-oriented procedures are suggested by the therapists. CBT is comprehensive but usually involves the maintenance of a diary to track significant events and related thoughts, feelings, and behaviors. The diary is also used to record assumptions, cognitions, beliefs, and evaluations that may be deleterious (Yau & Potenza, 2015). These procedures help the patient to stop the addiction and avoid relapsing.
Apart from CBT, self-help options are also available. These options have proved to be effective for many people but may be particularly beneficial for people who find psychotherapeutic options too intensive or costly. Internet-based programs, for instance, may help to reduce symptoms associated with disordered gambling. One of these programs is the Gambler’s Anonymous (GA) self-help group which helps victims to learn new ways of living (Yau & Potenza, 2015). Prevention strategies include conducting educational campaigns to enhance community awareness about the adverse effects of gambling addiction. Moreover, policies should be put in place to promote responsible indulgence in gambling activities.
Conclusion
Despite remarkable progress in research, behavioral addictions like gambling disorders are still poorly understood. The literature on effective treatment of behavioral addictions lags behind that of other common psychiatric ailments. Since these behaviors place a significant burden on the social and physical well-being of society, it is important to improve treatment and prevention strategies. The development of formal diagnostic instruments and health screens to assess various behavioral addictions will help minimize their public health burden.
References
- Leeman, R. F., & Potenza, M. N. (2011). Similarities and differences between pathological gambling and substance use disorders: a focus on impulsivity and compulsivity. Psychopharmacology, 219(2), 469-490. https://doi.org/10.1007/s00213-011-2550-7
- Nowak, D. E., & Aloe, A. M. (2013). The Prevalence of Pathological Gambling Among College Students: A Meta-analytic Synthesis, 2005–2013. Journal of Gambling Studies, 30(4), 819-843. https://doi.org/10.1007/s10899-013-9399-0
- Suomi, A., Jackson, A. C., Dowling, N. A., Lavis, T., Patford, J., Thomas, S. A., Harvey, P., Abbott, M., Bellringer, M. E., Koziol-McLain, J., & Cockman, S. (2013). Problem gambling and family violence: family member reports of prevalence, family impacts, and family coping. Asian Journal of Gambling Issues and Public Health, 3(1), 13. https://doi.org/10.1186/2195-3007-3-13
- Yau, Y. H., & Potenza, M. N. (2015). Gambling Disorder and Other Behavioral Addictions. Harvard Review of Psychiatry, 23(2), 134-146. https://doi.org/10.1097/hrp.0000000000000051
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