Gambling is not a new concept, playing a game for money or betting on an outcome that is not guaranteed to end in your favor has been around for ages. The act of gambling predates recorded history as well as modern currency. The first indication that a game resembling gambling existed was in the Old Stone Age, in France, where flat round pebbles painted on each side were probably flipped for heads or tails (Schleifer & Temple, 2009). The idea of it becoming a problem is not new either, a 19th century author states, “gambling vitiates the imagination, corrupts the tastes, destroys the industry,” dramatically emphasizing the destruction that can occur through addictive gambling (Beecher, 1896). Pathological gambling was officially considered mental disorder by the American Psychiatric Association when it was added to the Diagnostic and statistical manual of mental disorders 3rd Edition in 1980 (Lindeman, 2004). Pathological gambling was originally categorized as an Impulse Control Disorder and was given the same vague definition as the other disorders involving impulsivity, which was characterized by an irresistible impulse to perform harmful acts (Lindeman, 2004). Since then, it has evolved into what the Diagnostic and statistical manual of mental disorders (5th ed.) refers to as Gambling Disorder.

The key differences between a gambling addiction and regular gambling are the intensity and persistence that it affects an individual. Regular gambling is intended to be light hearted fun regardless of the outcomes. Responsible gambling can be practiced by only betting what you can afford to lose. Unfortunately, many get caught up in the moment and end up spending more than intended and then feel guilty. That scenario is relatively normal provided the person does not make it a repetitive behavior to the point of indigence. Most people gamble in social situations, which lasts for a limited period of time and people accept their losses. Professional gamblers are different from social and unhealthy gambling in that they have minimal risks and high levels of self-discipline.

In the Diagnostic and statistical manual of mental disorders (4th ed., text rev.), the diagnosis of Pathological Gambling was defined as “persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of” ten different symptoms. The symptoms for Gambling Disorder are similar to the previous diagnosis, Pathological Gambling, except they are rearranged in the DSM-V (2013) 5th ed., reduced to four or more of the symptoms, and specificity of the severity is included.

Gambling Disorder is categorized under substance related and addictive disorders, and in a subcategory of non-substance-related disorders. A person may have a Gambling Disorder if they are needing to gamble with increasing amounts of money in order to achieve the excitement they desire, restlessness or irritability when attempts to reduce or stop gambling are made, repetitive unsuccessful attempts to reduce, control, or quit gambling, and preoccupation thinking about gambling (APA, 2013). Additional symptoms include gambling when feeling distressed, after gambling and losing, lying to hide how much they gamble, jeopardizing or losing significant relationships, jobs, educational, or career opportunities, and relying on others to give them money in desperate financial situations that were created from gambling. To be diagnosed with Gambling Disorder, the person much have clinically significant impairment or distress as demonstrated by the aforementioned symptoms. Additionally, the gambling behavior cannot be better explained by a manic episode. The DSM-V (2013) 5th ed. notes that there are some other behavioral conditions are similar to substance related disorders, but gambling remains the only one with sufficient data to include in the section of addictive disorders (APA, 2013).

The specifiers of gambling disorder determine the severity of the individual’s condition based on how man of the criterion are met. If four or five of the previously listed symptoms are met, then the condition is considered mild, six or seven is moderate severity, and if eight or nine of the criteria are met then the person has a severe Gambling Disorder. The diagnostic features associated with gambling can manifest differently in various cultures and individuals. While it is perfectly normal in some cultures to gamble on games and events, some people take it to an unhealthy level. A cyclical and unrealistic pattern of attempting to chase losses and abandoning all strategy may emerge. People with a gambling disorder may lie to the people in their life, including therapists, family, and close friends to hide how involved they are with gambling. It is also possible that one might commit various crimes to obtain money with which to gamble, including but not limited to embezzlement, forgery, theft, or fraud. Associated features supporting a diagnosis of Gambling Disorder include distorted thinking, impulsivity, excessive energy, competitiveness, restlessness, depression, feelings of helplessness or loneliness, and up to half of people in treatment for gambling have suicidal ideations (APA, 2013).

There are various types of treatment options for all of the different substance-related and addictive disorders, some include religious programs, total institutional facilities, and various modalities of therapy. The recommended course of treatment for gambling depends highly on the individual and the comorbidity of other conditions. The following is an example of a person with Gambling Disorder and a treatment plan for the specific situation, utilizing cognitive behavioral therapy.

Dominique, a 21 year old male, sought counseling for gambling after three years attending school at Bum Fuck University (BFU). During the initial intake, Dominique outlined his background and presenting problems. Dominique was raised in a two parent home, and often witnessed his parents being physically violent with each other, when they were not drinking or partying. Dominique said it was not abnormal because they never hit him and they were actually ‘cool’ parents because they let him take beer in his room and play in an online casino. He stated they encouraged him to go to college and would not allow him to return home on vacations, claiming he needed his independence. As an alternative, Dominique began driving the four hours to New Orleans and gambling during the breaks from school. He made several friends that would allow him to stay weekends and holidays near the casinos. Despite not stating it as an immediate issue, Dominique illustrated how he was depressed whenever he was not in New Orleans. He explained that when he first made trips to gamble, he just used the money left over from student loans. In the last two years, Dominique’s gambling increased to the extent that he maxed out five credit cards and used all of his student loans, including book money on gambling. This year, Dominique has missed several classes because he was either in New Orleans or sleeping off the long nights. He stated that his school friends did not like him missing classes and tried to convince him to stop. Dominique revealed that he used play flag football with a group of friends two or three times a week. However, recently he has not had any desire to join them. Dominique admitted to losing several friends after lying about his gambling, claiming that he had stopped, begging them for money, and then spending it all in New Orleans. Dominique reported he really did try to stop a few times, but each time ultimately decided that it was better for his mental health if he continued. He illustrated that without the rush he gets from gambling, he often feels empty and hopeless. However, this year the feelings of worthlessness increased so much that when he did attend class, Dominique explained he had trouble concentrating and would rather be in bed hiding from the world. His primary reason for attending therapy is that his friends forced him because they do not love him. Dominique believes that if his parents, friends, or cousins loved him, they would give him money. He explained his attendance in therapy is only to satisfy his friends in order for them to give him money. Dominique also explained that he often thinks of death as an effort to escape the world, which was another factor that led his friends to ‘force’ him to attend therapy. Dominique stated he did not have a specific plan to commit suicide, only that the idea of death seems like a peaceful alternative to life.

The differential diagnosis for Dominique is 312.31 Gambling Disorder, 296.23 Major Depressive Disorder, and the World Health Organization Disability Assessment Schedule (WHODAS) was not administered. The development and course of his Gambling Disorder took place over several years. Dominique began gambling online as a teenager, and abusing alcohol at a young age. This behavior aggregated with his depression, which has worsened throughout his college years. Dominique reported feeling intensely sad at various times throughout his past, but gambling always made him feel better. The diagnostic criterion met to diagnose Dominique with Gambling Disorder included needing to gamble with increasing amounts of money, repeated unsuccessful attempts to stop gambling, gambling when he felt depressed, relying on others to provide money with which to gamble, and lying to hide how much he gambles. All of these culminated to the point of Dominique’s gambling behavior causing significant impairment and distress. Dominique also met the criteria for a diagnosis of Major Depressive Disorder because he exhibited depressed mood nearly every day, markedly diminished interest in activities he used to enjoy, hypersomnia, feelings of worthlessness, and recurrent thoughts of death. The determination not to administer the WHODAS was made based on previous scholastic performance and no apparent disability in psychological functioning.

The treatment plan developed for Dominique is based on the Cognitive Behavioral Therapy modality. Treatment goals:

Dominque will attend classes regularly and complete course assignments.

Dominique will identify, value, and state his feelings, thoughts, and wants.

Dominique will learn coping mechanisms for stressors and depressive symptoms.

Dominique will identify triggers for gambling and develop realistic alternatives.

Therapy should consist of approximately 6 to 12 sessions over 3 to 5 months. In the second session, Dominique agreed to the treatment plan and was willing to resume attending classes at BFU. The first goal in the course of treatment for Dominique is first behavioral activation, agreeing to attend his courses meant that he would not be leaving for New Orleans during the week. The second goal for Dominique will include learning to identify the automatic thoughts that he has when he wants to gamble as well as throughout the course of his days. This goal will be met when he has consistently demonstrated recognition of his thoughts, feelings, and wants. Dominique’s third goal will be achieved by learning and implementing healthy coping mechanisms for daily stressors and depressive symptoms. Dominique’s fourth goal will be reached when gambling no longer causes him clinically significant distress. This will be accomplished through a collaborative effort of identifying instances, or triggers, that make the urge to gamble stronger and countering those impulses with realistic alternatives.

If you or a loved one suffer from gambling addiction contact me today. (918) 732-9730