3/8/2010 - Is pathological gambling an addiction? You bet it may or may not be! Speaker: Prof Alex Blaszczynski.
Pathological Gambling is classified in DSM IV among the impulse control disorders, yet it appears to share many features with, and its diagnostic criteria modelled after, substance use disorders. What do they have in common, and can drug and alcohol services have a role in dealing with the problem? Do medications help? How should doctors, including drug and alcohol specialists, handle people with concurrent substance use and gambling problems? Can Protective Estates Orders be invoked?
Cases studies will present gambling problems in isolation and in combination with substance use problems.
Alex Blaszczynski is a Professor of Clinical Psychology and the Director of the Gambling Treatment Centre in the School of Psychology, University of Sydney and was Head of the Department of Medical Psychology at Westmead Hospital. He has conducted randomized controlled outcome cognitive and behavioural treatment studies, and investigated the prevalence of co-morbid substance abuse, withdrawal and tolerance phenomenon, and suicidality in pathological gamblers seeking treatment. He has written a self-help manual, "Overcoming Compulsive Gambling". He is editor of International Gambling Studies and Assistant Regional Editor for Addiction.
Learning objectives: at the end of this seminar the participant will be able to:
1. show knowledge of the epidemiology of problem gambling and gambling related harms in Australia, including gender, age, socioeconomic and ethnic factors and comorbid substance use.
2. demonstrate understanding of the multifactorial etiology of gambling pathology, including availability and modes of gambling, genetic predispositon, personality traits and disorders (extraversion, impulsivity), and environmental factors.
3. show awareness of the role of irrational beliefs and erroneous perceptions (superstition, illusions of control, expectancies of winning, attibutional bias, selective memory) in problem gambling and the implications for treatment
4. show understanding of the association of gambling with financial and interpersonal problems, with crime and depression, and of risk factors for suicide.
5. show understanding of the roles of psychotherapies, pharmacotherapies and harm reduction initiatives in promoting controlled gambling and gambling abstinence.
Pre-reading
International Gambling Studies, Vol. 8, No. 2, 179–192, August 2008
Withdrawal and Tolerance Phenomenon in Problem Gambling
ALEX BLASZCZYNSKI, MICHAEL WALKER, LOUISE SHARPE & LIA NOWER
The phenomenological similarities between gambling and substance dependence have led to the conceptualization of pathological gambling as an addictive disorder. Tolerance and withdrawal are important features of both disorders, suggesting commonalities in the neurobiological processes associated with neuroadaptational underpinnings. However, there are few empirical studies supporting the presence of tolerance and withdrawal reported in the gambling literature. Moreover, there are no studies comparing the equivalence of tolerance and withdrawal between gambling and alcohol dependence. This study compared tolerance and withdrawal features in samples of gamblers, alcoholics and gamblers who also met criteria for alcohol dependence. In contrast to the addiction model, findings indicate that, while a majority of participants increased bet size, the motivation to do so was not for excitement or to maintain arousal levels as indicated by the DSM-IV-TR but because of cognitive factors related to winning. Results supported the notion that pathological gamblers experienced similar levels of withdrawal symptom severity as alcohol-dependent participants. Further research is needed to evaluate whether those symptoms result from the inability to gamble or from the loss of an avoidant stress coping strategy.
Addiction. 2002 May;97(5):487-99.
A pathways model of problem and pathological gambling.
Blaszczynski A, Nower L.
At the moment, there is no single conceptual theoretical model of gambling that
adequately accounts for the multiple biological, psychological and ecological
variables contributing to the development of pathological gambling. Advances in
this area are hampered by imprecise definitions of pathological gambling, failure
to distinguish between gambling problems and problem gamblers and a tendency to
assume that pathological gamblers form one, homogeneous population with similar
psychological principles applying equally to all members of the class. The
purpose of this paper is to advance a pathways model that integrates the complex
array of biological, personality, developmental, cognitive, learning theory and
ecological determinants of problem and pathological gambling. It is proposed that
three distinct subgroups of gamblers manifesting impaired control over their
behaviour can be identified. These groups include (a) behaviourally conditioned
problem gamblers, (b) emotionally vulnerable problem gamblers and (c) antisocial,
impulsivist problem gamblers. The implications for clinical management are
discussed.
Suicide Life Threat Behav. 2003 Spring;33(1):88-98.
Pathological gambling and suicidality: an analysis of severity and lethality.
Maccallum F, Blaszczynski A.
Pathological gambling represents a major public health issue. Risk factors for
suicide such as major depression, substance abuse, marital breakdown,
unemployment, financial crises, and legal difficulties are commonly found in
populations of pathological gamblers. The objective of this study was to
systematically investigate the nature of suicidal behavior among
treatment-seeking pathological gamblers and its relationship to gambling
characteristics and depression. Indices of suicidality were assessed in a sample
of 85 treatment-seeking diagnosed pathological gamblers. High rates of suicidal
ideation, suicidal plans, and attempts were found; however, no clear relationship
was observed between suicidality and indices of gambling behavior. Depression
rather than gambling specific characteristics, marital difficulties, or the
presence of illegal behaviors appear to be related to the risk of suicidality.
Aust N Z J Psychiatry. 2002 Jun;36(3):411-5.
Pathological gambling and comorbid substance use.
Maccallum F, Blaszczynski A.
OBJECTIVE: The objective of this study was to determine the rates of substance
use problems in a sample of diagnosed pathological gamblers seeking treatment in
a university teaching hospital cognitive behavioural outpatient clinic. METHODS:
A semistructured interview schedule and the composite international diagnostic
interview (CIDI-auto) were administered to assess substance dependence in a
sample of 75 poker-machine gamblers meeting DSM-IV and South Oaks gambling screen
(SOGS) criteria for pathological gambling. Both the self-reported rates and the
proportion meeting criteria for a psychiatric disorder were determined. RESULTS:
The rates for substance use disorder within a sample of treatment-seeking
pathological gamblers is higher as compared to general population figures. Gender
differences were found with more current alcohol-abuse problems reported among
male than female participants. Non-alcohol-related substance abuse was relatively
lower than rates reported by other studies in the literature. CONCLUSIONS:
Substance abuse is a common comorbid condition of pathological gambling and
therefore should be screened for in routine clinical assessments. Failure to
identify and treat comorbid substance-use disorders in gamblers may lead to
higher relapse rates.
Behav Cogn Psychother. 2009 Jan;37(1):49-59.
Consequences of winning: the role of gambling outcomes in the development of
irrational beliefs.
Monaghan S, Blaszczynski A, Nower L.
BACKGROUND: The development and maintenance of gambling and problem gambling
with its corresponding irrational beliefs may be fundamentally linked to patterns of
wins and losses during electronic gaming machine (EGM) play. METHOD: The current
study investigated the extent to which irrational thoughts and erroneous
perceptions of chance differed based on individual wins or losses. Undergraduate
students (n = 45) completed questionnaires assessing irrational beliefs and
perceptions of chance prior to and following EGM play with credits rather than
money. RESULTS: It was found that players who lost reported a significantly
greater decrease in irrational thoughts and erroneous perceptions of chance and
significantly fewer superstitious beliefs than winning players following play.
CONCLUSIONS: Future studies are needed to further investigate the relationship of
winning to cognitive distortions to guide education and interventions.
