When gambling stops being a game…
The term addiction describes a specific type of relationship between a person and a behaviour that generates a particular sensory reward. It is a relationship qualified by a state of being out-of-control. It is easy to identify the problem in the case of alcohol or drug dependence where the sensory reward is the intoxicating effect of the use of mood-altering substances. However, in the case of gambling, the addictive relationship lies with a particular behaviour, namely the experience of risk derived from playing a game of chance that produces a sensory response – a heightened sense of arousal or mood.
Several explanations (or models) have been presented to explain addiction. These divide, more or less, into the models which stress biological or genetic causes – and those which stress social or purely psychological causes. Of course there are also many models which attempt to see addiction as both a physiological and a psychosocial phenomenon. The model used most frequently by addiction treatment professionals (including gambling addiction counsellors) is the disease model; addiction is a “disease of the brain”. The premise of the disease model of addiction is that addiction is a disease, coming about as a result of either the impairment of neurochemical or behavioural processes, or of some combination of the two (Meyer, 2001).
Addiction can be described as a complex “brain disease” (Leshner, as cited in van Wormer & Davis, 2008, p. 38). Many factors are thought to contribute to the development of this condition, including genetic, physiological, socio-environmental, psychosocial and nutritional. Weich (2006, p. 436) refers to addiction as an “irreversible, chronic, relapsing brain disease”. It is characterised by a loss of control – or powerlessness over the drug or alcohol being used, despite the negative effects and consequences it causes (Hutton, 2011). Addiction almost always features a level of psychological dependence, and often, physical dependence.
Ultimately, addiction is an addictive behaviour – one over which an individual has impaired control (powerlessness). The addictive behaviour creates harmful consequences (unmanageability).
Although it is effectively related to a quantity, both in time and amount, it is not the quantity in its own right that is exclusively the problem. In the end, whether it is substance abuse or gambling, the hallmark of the addict is determined not by ‘how much’ but by ‘how’ he does the activity, that is, the manner in which he engages in the addictive behaviour. Equally, loss of control is very often reflected in the consequences of the behaviour and not in the behaviour itself. The assessment of the consequences of the behaviour remains highly subjective and individualised.
In the light of this, the diagnosis of addictive gambling, along with most other addictive disorders, remains a particularly daunting challenge, requiring a frame of reference gleaned only through experience (Meyer, 2001).
What is gambling? Gambling is placing a bet on anything that has an unknown outcome.
Types of gambling
- Types of gambling include:
- Casino gambling – slots and tables
- Lottery tickets
- Scratch cards
- Internet gambling
- Sports betting
- Betting in the Tab
- Horse racing
- Stock exchange.
Types of gamblers
There are four types of gamblers – social gamblers, who can happily put R100 into a slot machine and walk away if they lose; problem gamblers, who will immediately play another R100 to try and make up for the R100 they have just lost (“chasing”); and pathological gamblers, who are obsessed with gambling and constantly thinking of how to find more money with which to bet. The fourth type is professional gamblers who are generally not addicted and gamble for a living.
Casual, social gamblers gamble for recreation, sociability and entertainment and gambling typically occurs with friends or family. These people gamble for fun rather than for the ‘certainty’ of winning, recognise that they are likely to lose, and don’t bet more than they can afford to lose. Thus, the gambling is controlled, lasts for a limited period of time and the losses are predetermined and reasonable. Gambling does not interfere with family, social or vocational obligations.
This describes an involvement in risky gambling behaviour that adversely affects the individual’s well being. This may include issues of relationships, family, financial standings, social matters and vocational pursuits (Arizona Council on Compulsive Gambling, Inc., 1995). The problem gambler experiences a preoccupation with gambling with impaired to poor, to periodic loss of control. There is a narrowing of interests and gambling continues despite adverse consequences. There are also failed attempts to cut down. Problem gamblers very often find themselves in in the losing phase (‘the chase’). Problem gambling is used to refer to the wider group of people who show some, but not all signs of developing a pathological gambling condition” (Bulwer, 2003).
Pathological (or compulsive) gambling is classified as an impulse control disorder and is recognised as a medical disorder by the American Psychiatric Association. It has the elements of addiction similar to alcohol and drug addiction. According to Sadock & Sadock, “Pathological gambling is characterised by persistent and recurrent maladaptive gambling that causes economic problems and significant disturbances in personal, social, or occupational functioning. Aspects of the maladaptive behaviour include:
- A preoccupation with gambling
- The need to gamble with increasing amounts of money to achieve the desired excitement
- Repeated unsuccessful efforts to control, cut back, or stop gambling
- Gambling as a way to escape from problems
- Gambling to recoup losses
- Lying to conceal the extent of the involvement with gambling
- The commission of illegal acts to finance gambling
- Jeopardising or losing personal and vocational relationships because of gambling
- A reliance on others for money to pay off debts” (2007)
Professional gamblers consider themselves skilled in the games they play and believe that they are able to control both the amount of time they spend gambling and the amount of money they spend on gambling. Generally, professional gamblers are not addicted to gambling. They are disciplined and they limit the risk by patiently waiting for the best bet, in order to win as much money as possible. They can be considered to be practicing a profession, rather than gambling.
Researchers from University Hospital of Bellvitge and the Autonomous University of Barcelona(Responsible Gambling Digest, 2010) identified subtypes of pathological gamblers:
- Type I (disorganised and emotionally unstable) is characterised by schizotypal personality traits, high degrees of impulsiveness, substance and alcohol abuse, psychopathological alterations and early onset age
- Type II (schizoid) exhibits high levels of harm avoidance, social aloofness, and alcohol abuse
- Type III (reward-sensitive) is characterised by high levels of sensation-seeking and impulsiveness, but without psychopathological alterations
- Type IV (high functioning) is a globally-adapted personality type, without any disorders relating to substance abuse, and no associated psychopathological alterations.
Clinical implication of this research is that pathological gambling is a highly heterogeneous disorder that may require different therapeutic approaches according to its specific characteristics.
Reflecting on how perspectives have changed in the field of research on gambling disorders, Black (cited in Black, Goodie, Wynne & Goudriaan, 2010) suggested that the most significant change was that pathological gambling was included in the Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. in 1980. “This set off a paradigm shift away from disordered gambling being considered strictly a social and behavioural phenomenon, to that of it being a neuropsychiatric disorder” (Black, 2010, p. 1).
A May 2011 report states that pathological gambling “will be reclassified from a behavioural disorder to an addiction, as of 2013. For more than 30 years, doctors have considered pathological gambling a behavioral disorder, not an addiction. But that’s about to change. In 2013, the psychiatric community will officially classify uncontrolled gamblers as addicts — the first-ever ‘behavioral addiction’. Pathological gambling will no longer be an impulse-control problem” – like pyromania, kleptomania or trichotillomania (Mangels, 2011). This reclassification of pathological gambling with Substance-related disorders – including substance dependence and substance-induced disorders will be contained in the next edition of the American Psychiatric Association’s Diagnostic and Statistical Manual, the textbook that guides diagnosis and treatment.
A “psycho-bio-social” perspective on gambling research was presented by Wynne (2010) – in order to best understand the behaviour associated with problem gambling. He considers the “social milieu” in which the problem gambler exists, that is, the peer group, the family, the work environment, the cultural group and the community to be significant. As gambling is a social activity, research attention needs to be paid to the external factors which influence the gambler’s behaviour.
- Various factors play a role in causing pathological gambling:
- Comorbidity is common and is being researched in South Africa, notably:
- Other addictions
- Depression and Anxiety disorders
- Post traumatic stress disorder.
- Males are more likely to be pathological gamblers than females:
- Male predictors are anxiety (hyper-arousal) and dissociation
- Female predictors are depressed mood, dissociation and use of stimulants
- The majority of females began pathological gambling later in life:
- Gravitated towards one object of addiction
- Progressed more rapidly to dependency
- Quicker to seek treatment
The proportion of pathological gamblers among adolescents is higher than in adults. The younger the gambling starts – the more likely it is to develop into pathological gambling.
- There is a higher risk of developing problem gambling if people are using gambling:
- In the hope of solving money problems
- As a means of escaping painful realities such as relationship problems, divorce, job loss, retirement or death of a loved one
- In order to cope with a health concern and/or physical pain
- As an antidote to loneliness
- As an antidote to boredom
- To anaesthetise themselves against negative feelings or events, such as depression and anxiety and situations which provoke them
- As a reaction to a history of abuse or trauma
- As one amongst a cluster of problem behaviours such as excessive use of alcohol or other drugs or overspending
- In gambling addiction there is also:
- Genetic component
- Environmental factors
- Gambling related superstitions and false beliefs – which means people gamble more than can afford to lose
Process of gambling addiction
- The process of gambling addiction can be described as:
- Winning stage – Impaired control – Comfortable passing of time; recreational activity; excitement and entertainment; initial period of winning; increased self esteem
- Losing stage – Poor control – Increased tolerance with more time spent gambling; higher stakes and bigger losses; gambling with borrowed money; secret gambling; promises to stop
- Critical stage – Loss of control “chasing” – Onset of “consequences”; problems with finances, relationships and work; failed attempts at control; rationalisation of behaviour
- Desperate stage – Absence of control – Gambling is a full-time occupation with loss of
social supports and work; criminal offences; social misfit; depression and suicidal behavior
Black, D. W., Goodie, A.S., Wynne, H. & Goudriaan, A. (2010). Looking back: Perspectives on changes in the field of research on gambling disorders. Issues & insights, 1-2.
Bulwer, M. (2003). Treating gambling addiction: A psychological study in the South African context (Masters thesis). University of South Africa, Pretoria.
Hutton, B. (Ed). (2011). Recovery RSA: A resource book for those affected by addiction. Johannesburg, South Africa: Stonebridge Books.
Mangels, J. (2011). Psychiatric community decides to classify uncontrolled gamblers as addicts, which could change how society views them. Retrieved from www.responsiblegambling.org/articles/Psychiatric_community.pdf
Meyer, R. (2001). National Responsible Gambling Programme: Treatment protocol for the gambling addiction network counsellors. Cape Town.
National Responsible Gambling Programme. (2010). Scientists identify four types of compulsive gamblers. Responsible Gambling Digest, 10/10, 19-20.
Sadock, B. J., & Sadock, V. A. (2007). Kaplan & Sadock’s synopsis of psychiatry: Behavioural sciences/clinical psychiatry (10th ed.). Philadelphia: Lippincott Williams & Wilkins.
Van Wormer, K., & Davis, D. R. (2008). Addiction treatment: A strengths perspective (2nd ed.). Belmont, CA, USA: Thomson Brooks/Cole.
Weich, E. M. (2006). Substance use disorders. CME (Continuing medical education): The SA journal of CPF, 24:8, pp. 436-440.