“Gambling: The sure way of getting nothing from something.” – Wilson Mizner
Who doesn’t enjoy a game of chance now and then? Trying your luck on an inexpensive lottery ticket can seem innocent enough, and might even net you considerable return. Spurred on by the lure of winning the big jackpot through television, radio, Internet, newspaper and other media ads may even prompt you to spend more than you intended. And it’s not just lottery tickets that people become hooked on but other forms of gambling as well: horse racing, slot machines, card games, sports betting. It should come as no surprise, then, that gambling use disorder (GUD) has steadily gained prominence as another form of addiction.
New research on gambling addiction and GUD is both illuminating, troubling, and promising with respect to prevention, treatment and recovery.
Gambling Officially Recognized in DSM-5 as Behavioral Addiction
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) took gambling out of the “Impulse Control Disorder” section and reclassified gambling disorder as part of the expanded section covering “Substance-related and Addictive Disorders.” With this action, gambling disorder is the first non-substance behavioral addiction. A 2016 review in Substance Abuse and Rehabilitation examined the similarities and differences between gambling disorder and substance use disorders (SUDs) and found many shared characteristics, some of which include diagnostic criteria, comorbidity, genetic and physiological factors, even approaches to treatment.
Suicide Rates Increasing Among Those with Gambling Disorder
While previous research found that gambling disorder appeared to be an independent risk factor for suicide, and few studies looked at all-cause mortality as it relates to gambling disorder, 2018 research published in the Journal of Behavioral Addictions explored both mortality and suicide rates in those with gambling disorder and the general population, as well as risk factors associated with mortality due to suicide and all causes. Their findings showed significantly elevated rates of mortality and suicide among those with gambling disorder. Furthermore, even though common comorbid mental health issues did not predict overall mortality, depression was found to predict suicide death. Researchers suggested that medical and mental health professionals pay attention to long-term risk of death in their patients with gambling disorder and promote effective interventions for mental heath and other comorbid conditions.
Personality Disorders Consistently Associated with Pathological Gambling
In 2017 review published in Current Opinion in Psychiatry, researchers found a strong association between pathological gambling and personality disorders. They noted that studies consistently showed that the presence of a personality disorder is associated with severity of gambling and early age of onset of pathological gambling. Researchers called for further research on pathological gambling that goes beyond merely estimating rates of personality disorders and instead concentrate on longitudinal research to understand both the pathways between personality disorders and the early onset and severity of pathological gambling.
Disordered Gamblers Seeking Treatment Frequently Have Psychological Distress
What used to be called problem gambling or pathological gambling is now generally referred to as disordered gambling, according to several sources, including the New York Council on Problem Gambling. A 2017 study published in the Journal on Gambling Studies examined psychological distress as an indictor of co-occurring psychopathology among disordered gamblers seeking treatment. They found evidence of severe gambling pathology among those with greater levels of psychological distress. Furthermore, greater scores of psychological distress was found to significantly predict anxiety, depression, and deviancy. Researchers suggested that clinicians treating disordered gamblers may want to conduct a brief screening to check for the presence of co-occurring psychopathology, especially with reference to measures of psychological distress. The results could greatly aid clinicians in determining effective treatment approaches for disordered gamblers with psychological distress.
Co-morbid PTSD and Gambling-Related Cognitions: How They Affect Treatment
A 2018 study published in Addictive Behaviors looked at the association of post-traumatic stress disorder (PTSD) and gambling disorder in individuals with both conditions. Researchers sought to determine how PTSD might be related to specific gambling-related cognitions in terms of expression and experience. Hypothesizing that those with symptoms of PTSD (or symptoms of PTSD, even if undiagnosed) would show greater erroneous beliefs and cognitive distortions about gambling, researchers found the study participants consistently reported greater gambling-related cognitions. This led researchers to suggest that PTSD is uniquely associated with increased levels of cognitive distortions and erroneous beliefs about gambling and, further, that the findings both add to current understanding about the relation of PTSD and gambling to each other and to treatment of those diagnosed with the co-morbid conditions.
Other 2018 research published in Psychology of Addictive Behaviors postulated that PTSD symptoms were likely to be associated with unique beliefs about types of gambling behavior and unique motivations to gamble. Researchers studying two groups, an inpatient group of U.S. Armed Forces veterans in treatment for gambling disorder and an online sample of gambling adults found that symptoms of PTSD were related to positive expectancies for gambling and consistently associated with greater coping mechanisms for gambling for both sample groups. Researchers said that the high co-morbidity of symptoms of PTSD and gambling disorder are likely of interest for clinicians treating individuals for either PTSD or gambling disorder (or both).
Flashing Casino Lights/Sounds: Influence Risky Decision-making and Promote Problem Gambling?
Research published in the Journal of Neuroscience indicates a possible connection between the sensory cues of flashing lights and sounds in casinos and increased risky decision-making, potentially even promoting problem gambling behavior. Researchers from the University of British Columbia found that individual choices were less influenced by the odds of winning when the gambling environment featured the audio and visual sensory cues. In other words, they took more risks in gambling despite the odds. Researchers suggested that the findings might help explain why individuals continue to gamble even though the odds of winning are against them. In addition, they said that gambling sights and sounds are far from innocuous and may form an important piece of the puzzle surrounding gambling addiction in that such environmental cues encourage risky decision-making and bias attention.