Gambling disorder

Gambling disorder also known as compulsive gambling or disordered gambling is a pervasive disorder and addiction characterized by continuous gambling, preoccupation with obtaining money for gambling, and a continuation of the gambling behaviour despite facing adversities and potential loss of control over this behaviour. Gambling disorder often referred to as pathological gambling does not involve a chemically addictive or psychoactive substance, but it is considered by clinicians to be an addictive disorder because of the personality factors of compulsive gamblers which is similar to that of the individuals having substance-use disorders.

Compulsive gambling involves a maladaptive behaviour that disrupts the social, occupational and interpersonal life of the affected in the long run to reap the benefits of the short-term gains. Research studies have proven that alcohol abuse and personality disorders are comorbidities existing with pathological gambling. 

Prevalence: 

Pathological gambling is prevalent among the adult population globally where 1-2 per cent of the individuals are affected by this disorder. Individuals assigned as male and female at birth are equally vulnerable to compulsive gambling. Although these statistics vary over high-risk populations, where alcoholics are much more vulnerable to acquiring pathological gambling disorder. A research study (Pietrzak, 2007) portrayed that individuals having gambling disorders are much more prone to abusing alcohol and nicotine compared to non-gamblers.

Moreover, in Southeast Asia, surveys (conducted in Laos) have reported an epidemic of compulsive gambling. Gambling in casinos, betting on horse races or sports like cricket and online games like poker over the browser are various forms that lead to gambling addiction. Pathological gamblers commit crimes in the field of gambling and often turn violent and aggressive.

Aetiology: 

Research reports portray that an individual’s control over gambling is associated with the duration and frequency of the time spent on betting. Another possible reason why individuals get addicted to gambling is due to the reinforcement during their introductory phase where they have won a substantial amount of money. These individuals often believe that this beginner’s luck might work in their favour and thus result in a large sum of money.

Moreover, since it is a chance factor, everyone wins a sum of money from time to time and receives the reinforcement (i.e., a chunk of money) intermittently. This reinforcement schedule – “intermittent reinforcement” which is the most potent schedule of operant conditioning leads to individuals becoming pathological gamblers despite being exposed to excessive losses. 

Individuals who are addicted to gambling are well aware of the limited rate of success, but they continue to gamble despite knowing the odds against them. Moreover, this significantly impacts their occupational or academic, social and interpersonal life where they dismiss the savings in their betting schemes, and avoid their families and friends. Additionally, they take loans having heavy interest rates from companies or borrow it from their friends. Some of them resort to petty thefts and illegal channels to procure the sum needed for gambling.

A research report (Rosten, 1961) depicted that compulsive gamblers are rebellious and unconventional individuals who do not conform to the ethical norms and values of society. Nearly 50 per cent of the individuals who participated in the research denoted themselves as people who hate regulations.

Furthermore, they were overly optimistic about the day establishing that “it’s their day” where they would potentially win a large sum. These individuals would further engage in the rational analysis that they have been waiting for their turn for a very long time and that they would hit the jackpot ‘that day’ despite incurring heavy losses, i.e., which is referred to as the Monte Carlo fallacy.  

Studies conducted by Hollander and his colleagues in 2000 depicted compulsive gamblers as rebellious, impulsive and thrill-seeking, often engaging in antisocial behaviours. These individuals are often diagnosed with substance-use disorders and impulse disorders. A few research reports have also suggested that pathological gambling develops as a result of childhood trauma, isolation, abuse and neglect.

Moreover, the dopamine pathway responsible for reward and motivation might be dysregulated due to which individuals are predisposed to this disorder. Furthermore, the impairment of the pre-frontal cortex which caters to executive functioning can elicit impulsivity. Few research studies have also shown that compulsive gambling might develop as a result of genetic predisposition. 

Symptoms: 

Gambling disorder progresses through stages, initially viewed as occasional gambling for recreation or entertainment and thus evolves into compulsive behaviour with severe negative consequences impairing daily functioning. The affected individuals may exhibit denial about the severity of their problem, further delaying their assessments and intervention reports.

Compulsive gambling is a persistent and recurrent pattern of problematic behaviour that causes distress to the affected individual and others surrounding them. Moreover, these symptoms are not better accounted for by a manic episode, ensuring that the behaviour is not merely a secondary feature of another mental health condition. Four of the following symptoms must be present to clinically diagnose the gambling disorder and the same should be exhibited for at least a year. 

• The individual needs a progressively larger sum in order to experience the same amount of excitement. This further builds their tolerance, where the individual bets more to attain the desired outcome and exhibits diminished response to smaller bets. 
• The individual shows irritability and restlessness when they attempt to cease or limit the activity. This indicates the dependence of the individual on gambling, where the individual faces negative emotions when not associated with this particular activity. 
• The individual is aware of the negative consequences of gambling, but despite knowing the possible harms, they are unable to reduce this habit. Moreover, the individual has already made several unsuccessful attempts to quit or limit their gambling pursuits. They struggle to implement the change despite recognizing the need for curbing this activity. They might have tried to set limits but have failed to do so consistently.
• The individual frequently dwells upon the activity of gambling pondering about their past experiences and strategizing for obtaining money for further opportunities. This obsessive focus on gambling disrupts their daily functioning.
• Individuals use gambling as a coping mechanism or as a means of escaping reality when exposed to adverse situations, thereby engaging in gambling when they are distressed, helpless, anxious, guilty or depressed to alleviate these negative emotions. 
• The individual feels compelled to continue gambling post losses in order to compensate and recover the lost amount. This is referred to as “chases losses”. This vicious cycle of recouping their lost sum drives these individuals into bankruptcy and exacerbates their financial issues.    
• The individual often lies and deceives the family members and friends in the pursuit of gambling. They lie to conceal their gambling habits which further erodes trust in relationships. 
• An individual can lose their vocational or educational opportunity or might lose a relationship as compulsive gamblers devote most of their time towards their pursuit of gambling. It deteriorates the relationships at the workplace or educational institutions and home.
• The individual relies on friends, family and peers for financial support to alleviate themselves of the financial constraints caused due to gambling like repaying debts or essential living expenses. This further leads them to financial instability and potential legal issues

Treatment: 

Treatment of pathological gambling is parallel to that of addictive disorders, among which the most extensive treatment approach used is cognitive behavioural therapy (CBT). However, the relapse rates post-therapeutic interventions are very high. Few research studies that depict improvement for individuals who have been administered therapeutic interventions also report the individual’s difficulty remaining abstinent.

Moreover, Gambler’s Anonymous (GA), a support group was established which showed effective results, it was modelled after Alcoholics Anonymous. Although the results of these interventions were proven to be effective, during the follow-up sessions, relapses of pathological gambling were found. According to the study by McComb in 2009, when problems related to family dynamics were addressed during therapeutic interventions, it led to more positive outcomes.

Additionally, motivational interviewing (MI) proved to be effective as it enhances the individual’s motivation to change their gambling behaviour. Furthermore, financial counselling helps these individuals figure out their debt scenarios and adopt healthier financial habits. Medications like antidepressants and mood stabilizers are prescribed by clinicians and psychiatrists to help them cope with underlying mental health conditions. 

Pathological gambling has become increasingly prevalent in recent times due to the widespread availability of online gambling opportunities like PokerBaazi and RummyCircle. Moreover, liberalized gambling laws have further contributed to this trend by allowing state-operated lotteries, horse racing, and casinos as a means to boost state tax revenues. In this environment, where gambling is both easily accessible and socially sanctioned, the likelihood of pathological gambling rising significantly is high, and individuals might end up in a vicious cycle of financial instability due to gambling addiction.

Since pathological gamblers often show resistance to treatment, it is essential to intensify efforts to develop more effective prevention strategies and treatment approaches to address this growing issue. Furthermore, raising awareness about the risks and signs of gambling addiction along with limiting access to gambling opportunities, especially to the vulnerable population can aid in the prevention of this addiction.