In this post you will learn more about how gambling addiction is defined, how and why it manifests and the most effective treatment models. Gambling addiction can also be called problem gambling, compulsive gambling or gambling disorder.
What is problem gambling?
Problem gamblers often refer to their zone of emotional comfort, where nothing else seems to matter to them whilst they are being consumed by their pleasure seeking activity. Their gambling, whether that is actually doing it or thinking about doing it, can offer a kind of emotional buffer zone against uncertainty in life.
People who experience episodes of gambling that is out of control will often reveal that they had been worried about something in their life, such as their health, for example, or were feeling anxious about facing an important business decision or were worrying about the wellbeing of someone else in their life. Having such uncertainty in life can be discomforting and addictive behaviour can be the ultimate avoidance of having to process difficult feelings. It is almost like an existential need for action, where the actual aim is not necessarily to win, but merely to continue. Continuing means not having to address such difficult feelings or emotional states.
Diagnostic tools for assessing problem gambling
Screening tools for clinicians are the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria for gambling disorder and the Problem Gambling Severity Index (PGSI). Gambling had been previously defined as an impulse control disorder in early iterations of the DSM from 1980 (up to the fourth), but it is now listed in the latest iteration of the manual (DSM-V) as a substance related disorder. Gambling is, therefore, the only “official” behavioural addiction defined by psychiatrists, with gaming being an area for further consideration.
The International Statistical Classification of Diseases and Related Health Problems (ICD) currently in its 11th edition, includes classification for mental disorders, but, unlike the DSM, also offers diagnostic criteria for conditions and diseases related to all other body systems (e.g.,respiratory, circulatory, musculoskeletal, etc).
The Brief Biosocial Gambling Screen (BBGS) is a 3-item survey and the NODS-SA is self-assessment version of the NODS (the NORC Diagnostic Screen for Gambling Disorders) are other diagnostic tools.
Why does problem gambling occur?
The Gambling industry player protection tools will allude to the need for stopping and taking time out when the fun stops. The trouble with this is that such messages do not reflect the true nature of the problem. Gambling by its very nature is highly addictive given its effect on the reward centres of the brain, gambling addiction activates the same brain pathways as drug and alcohol cravings, and gambling platforms are designed to be addictive with their inbuilt variable reward schedules. Whilst the ads might allude to the fun that can be had, the reality is that gambling can quickly lose its entertainment value and can very easily become total absorption. The gambling companies’ player protection literature state that users should make sure that they are not becoming dependent on gambling but this can be like the drug dealer offering health promotion advice as they peddle their substances.
Gambling offers an apparent quick fix to escape emotional discomfort, leading to the creation of an escaped zone. This zone promises relief from emotional pain where users can seemingly forget about their worries. Gambling can become increasingly more and more problematical when emotional oblivion is being sought. Users will refer to being trapped, like they are bargaining with chaos and the difficulties they are seeking to escape from end up coming flooding back ferociously, leading to the need for greater and greater stimulation.
Problem gamblers refer to their addiction being like a vacuum cleaner that sucks the life out of them and sucks them out of life. They don’t show up for social engagements. They regularly go missing and often lead a double life. They fail to make binding commitments for most things occurring in the future. The people that they share their life with will refer to them not being present, that they are highly avoidant. There is no time for anything other than their gambling, meaning there is less focus on their work, creative life, relationships and leisure. Time drifts by and problem gamblers can relate stories of how life seemingly passes them by.
How to spot gambling addiction
The ‘four Cs of addiction’ is often used in counselling for addiction when seeking to understand if a behaviour has become problematical. It can be a useful starting point to spot symptoms. The four are:
- Compulsive
Gambling when there had not being any prior plans.
- Control (loss of)
When gambling behaviour fails to stick to limits there might be a loss of control.
- Continuation (despite negative consequences)
A behaviour ceases to be fun or have entertainment value when there are increasingly negative consequences occurring in the user’s life.
- Craving (or mental obsession)
Craving is usually associated with chemical addiction, however, it may be that certain behaviours represent a negative urgency and a form of impulsivity.
The 6 core components model is another basic tool that can also be useful in the treatment of addictions: (note that not all 6 need to be met).
- Salience
Gambling is all someone talks about.
- Mood modification
A period of gambling activity helps to change mood and overcome difficult feelings.
- Tolerance
Greater stimulation is required to have the same affect.
- Withdrawal symptoms
Suffering mentally and emotionally when not able to indulge in gambling.
- Relapse
Relapse can be a reoccurring feature of intended abstinence.
- Conflict
Someone has an unresolved internal conflict(s) driving their gambling behaviour.
The following questions form part of another basic screening tool designed to help you to identify instances of compulsive gambling, whether for yourself, a loved one or someone you are seeking to help professionally. It is reasoned that most compulsive gamblers will probably answer yes to at least seven of these questions relating to their gambling activities. Medical clinicians will most likely not use this one. However, this can be a starting point when assessing whether recreational gambling has passed over an invisible line into the area of problem gambling. Gamblers Anonymous (GA) use these questions as part of their 12 step programme of recovery from active addiction.
- Y / N – Did you ever lose time from work or school due to gambling?
- Y / N – Has gambling ever made your home life unhappy?
- Y / N – Did gambling affect your reputation?
- Y / N – Have you ever felt remorse after gambling?
- Y / N – Did you ever gamble to get money with which to pay debts or otherwise solve financial difficulties
- Y / N – Did gambling cause a decrease in your ambition or efficiency?
- Y / N – After losing did you feel you must return as soon as possible and win back your losses?
- Y / N – After a win did you have a strong urge to return and win more?
- Y / N – Did you often gamble until your last dollar was gone?
- Y / N – Did you ever borrow to finance your gambling?
- Y / N – Have you ever sold anything to finance your gambling?
- Y / N – Were you reluctant to use “gambling money” for normal expenditures?
- Y / N – Did gambling make you careless of the welfare of yourself or your family?
- Y / N – Did you ever gamble longer than you had planned?
- Y / N – Have you ever gambled to escape worry, trouble, boredom or loneliness?
- Y / N – Have you ever committed, or considered committing, an illegal act to finance gambling?
- Y / N – Did gambling cause you to have difficulty in sleeping?
- Y / N – Do arguments, disappointments or frustrations create within you an urge to gamble
- Y / N – Did you ever have an urge to celebrate good fortune by a few hours of gambling?
- Y / N – Have you ever considered self destruction or suicide as a result of your gambling?
Treatment for problem gambling
Problem gamblers often suffer in silence. They are used to hiding their problem. Abstinence based treatment programmes are invariably what are needed in order to effectively address the underlying issues concerning a preoccupation with betting and gambling, at least initially. The therapeutic task is to help someone stop and then to stay stopped by gaining insight to triggers, whilst the underlying emotional issues are addressed.
The tools associated with the Cognitive Behavioural Therapy (CBT) approach can be effective to help break down the deeply held denial patterns of the problem gambler as well as helping to maintain abstinence. However, longer term recovery might require existential interventions to address underlying lack of purpose and meaning in life, anxieties related to mortality or illness. Problem gamblers might also have untreated early trauma that requires a programme of healing and transformation.
Therapy might involve an underlying tension between theoretical belief systems, such as whether addiction is caused by an inherent allergy (as proponents of the disease model would advocate) or whether obsessive and compulsive behaviour is a response to the difficulty of processing uncomfortable feelings and emotions. This tension could be described as the nature/nurture debate around the causes of addiction. One form of treatment might be total abstinence, essentially forever but presented as a daily practice, whilst another form might entail damage limitation gambling following an initial period of abstinence.
Gambling is effectively designed to be addictive given its subtle reliance on variable reward schedules. This is how casinos operate as businesses. The reward centres of the brain light up when gambling in a similar way to drug taking. Yet those advocating nature as the cause of addiction would argue that there is a form of pre-determination, or pre-disposition, perhaps inherited factors such as one’s genes that makes a user become an addict. Once a gambler who is pre-disposed to problem gambling starts, there is an inevitability of un-manageability and powerlessness over gambling at some point in the future. Studies suggest problem gamblers may have lower impulse-control than the general population. This view underpins the Gamblers Anonymous (GA) 12 steps of recovery and is generally what underpins treatment approaches in rehabilitation clinics.
GA is based on the principles of the 12 steps of recovery first instigated by Alcoholics Anonymous (AA), where alcoholism is viewed as a 3 fold illness based on the idea that there is an allergy to alcohol. Treatment by means of the 12 steps of recovery is focused on the objective of ongoing abstinence, developing a spiritual life and successfully dealing with gambling urges.
The nurture side of the debate, on the other hand, would rather emphasise the adverse social/environmental factors that might have negatively influenced an individual’s ability to emotionally regulate. Such factors might have been early trauma, attachment disorders and having co-morbidities such as anxiety and depression, for instance. Gambling could be a way of seeking to avoid difficult feelings and emotions, intolerable mental states, traumatic memories and general discontent in life. Certain factors leave some people at greater risk of addiction. This can include having family members with addictions, and parental figures offering gambling inducements from an early age by bringing children to the amusement arcade or the racetrack.
For proponents of the nurture side of the debate, users are seeking to escape into their gambling zone, which promises release from worry and a sense of meaningless. Their gambling behaviour is not necessarily based on the manifestation or an activation of some form of allergy but is more like a process of self-medication. Some in the nurture camp, whilst disputing the allergy basis of addiction might, nevertheless, concede that there could be some form of maladjusted brain reward circuitry which leads to the problem gambler wanting more and more stimuli.
The important message here is that you can stop and take stock of your life if you are suffering from the damaging consequences of behavioural addiction such as gambling. Your recovery journey can start here and now. Th truth for problem gamblers is that it is almost impossible to win, as successful wagering requires discipline in addition to adhering to successful wagering strategies. Problem gambling, by its very nature, is devoid of discipline. Problem gamblers would not be able to maintain adherence to a winning strategy in the long term, even if such a strategy existed.
Speaking to a trained professional will help to create the appropriate conditions for you to make positive choices in your life. Your personal zone of gambling may have promised apparent emotional comfort in the past, but might not be serving you now.
Noel Bell is an accredited psychotherapist based in London and on-line who is experienced in treating problem gambling. Email noel@noelbell.net or call (44) 7852407140
Step 12 is the most spiritual of all the GA steps in my opinion. Thanks.