Pathological gambling

Gaming pathy is a disorder in which the person is forced, by an uncontrollable psychological urge to play and bet in a casino or other betting system, persistently and progressively, affecting in a negative way to personal, family and vocational life. Although in previous editions of the DSM diagnostic manual it had been classified as an impulse control disorder, it has been conceptualized and treated as an addiction without substance, until in the DSM- V has finally been included within the category of "Substance-related disorders and addictive disorders".

Pathological gambling is classified in the DSM-IV-R in impulse control disorders, which also include kleptomania, pyromania and trichotillomania, in which impulsivity would be involved, but it does not present comorbidity with these disorders. Although the DSM system (III, III-R and IV1) and the ICD-10 include this disorder among the disorders due to low impulse control, the truth is that the DSM operational diagnostic criteria have exactly the same design as the DSM diagnostic criteria. of addictions to substances, which shows the underlying conception for the disease in that system: it is an addictive problem "without substance" included in a different section than yours.

Gambling is characterized by difficulty controlling impulses. It tends to manifest itself in the compulsive practice of one or more games of chance. It can affect the daily life of the addict, in such a way that family, sex or even food become secondary. Therefore, it should not be confused with a vice, since gambling is a serious chronic disease, an addiction.

In addition to affecting the individual and family level, it also affects the social level, decreasing the time for other activities and at the work level, producing a professional loss of prestige and the possible loss of employment.

APA classification

Pathological gambling was officially recognized as a mental health disease entity in 1980 when the American Psychological Society (APA) included it for the first time as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, in its third edition. (DSM-III).

1. Concern. The subject has frequent thoughts about experiences related to the game, whether present, past or product of fantasy.
2. Tolerance. As in the case of drug tolerance, the subject requires larger or more frequent bets to experience the same emotion.
3. Abstinence. Concern or irritability associated with attempts to quit or reduce the game.
4. Evasion. The subject plays to improve his mood or avoid problems.
5. Get up. The subject tries to recover the losses of the game with more game.
6. Lies. The subject tries to hide the amounts intended for the game by lying to his family, friends or therapists.
7. Loss of control. The person has tried without success to reduce the game.
8. Illegal acts. The person has violated the law to get money for the game or recover the losses.
9. Risk significant relationships. The person continues to play even though it means risking or losing a meaningful relationship, employment or other opportunity.
10. Other resources. The person uses the family, friends or third parties to obtain financial assistance as a result of the game.

Phases

According to Becoña, there are three phases of addiction:

1. Gold Stage: The player is more aware of what he gains than what he spends.
2. Stage of desperation: The player realizes the lost.
3. Acceptance: The player becomes aware of his problem.

Biological basis

According to the Illinois Institute for Addiction Recovery, the latest evidence indicates that pathological gambling is an addiction similar to chemicals. Some pathological gamblers have been shown to have lower levels of norepinephrine than normal gamblers.

According to a study led by Alec Roy, M.D., a former fellow at the National Institute on Alcohol Abuse and Alcoholism, norepinephrine is secreted under conditions of stress or threat, so pathological gamblers gamble to raise their levels.

Expanding on this, according to a report from the Harvard Medical School Division on Addictions, an experiment was generated in which the subjects were presented with situations in which they could win or lose in an environment that simulated a casino. Subjects' reactions were measured using fMRI, a neuroimaging technique very similar to Nuclear Magnetic Resonance. And according to Dr. Hans Breiter, co-director of the Center for the Neuroscience of Motivation and Emotion at Massachusetts General Hospital, "cash rewards in a gaming environment produce brain activation very similar to that seen in a cocaine addict receiving a dose."

Serotonin deficiencies can also contribute to compulsive behavior, including gambling addiction.

Relation to other problems

As debts mount, those affected may turn to "solutions" desperate to get money in order to recover it through gambling, such as petty theft, or request new credits to cover the most difficult to hide debts. The existence of the criminal act depends on the facilitating circumstances of the environment to commit it and the basic personality of the person affected.

As a consequence of the disease, the affected person may have depression, anxiety, heart attacks (a consequence of stress), they may have suicidal ideation out of despair if they do not receive treatment.

On the other hand, a considerable number of those affected have attention deficit hyperactivity disorder (ADHD).

It is also known that some antiparkinsonian drugs can cause compulsive gambling.^{[citation needed]}

A 1991 relationship study of American men found that 10% of compulsive gamblers had been married three or more times. Only 2% of non-players had been married more than twice.

Prevalence

A study by the UK Gambling Commission, the "British Gambling Prevalence Survey 2007", found that approximately 0.6% of the adult population had problem gambling, the same percentage as in 1999. The highest prevalence of compulsive gambling was found among participants in spread betting (14.7%), fixed betting terminals and betting exchanges (11.2%).

In Shaffer and Hall's 1996 meta-analysis of the prevalence of pathological gambling among adolescents (13 to 20 years old), the estimated mean for pathological gambling or severe gambling problems ranged from 4.4% to 7.4%..

Available scientific knowledge seems to indicate that pathological gambling is an internal tendency and that pathologists tend to risk money on any available game, rather than on a particular one, creating pathological gambling in other individuals who would otherwise be &# 34;normal". However, research also indicates that gamblers play rapidly developing games. They are therefore much more likely to lose money playing roulette, blackjack, craps, poker, sports betting or a slot machine, where cycles end quickly and there is a constant temptation to play again and again or increase the stakes, as opposed to national lotteries, in which the player must wait until the next draw to see the results.

Henry Lesieur, a psychologist with the Rhode Island Hospital gambler treatment program, claims that 30 percent of the profits from gaming machines come from gamblers.

Dopamine agonists, particularly pramipexole (Mirapex), have been implicated in the development of compulsive gambling and other excessive behavior patterns.

Argentina

For Isabel Sánchez Sosa, coordinator of the Compulsive Gamblers Association of Argentina, "in the country gambling addiction is growing a lot because the offer is impressive" and in this sense, she asserted that the presence of bingos is a common issue in all neighborhoods.In the province of Buenos Aires there are 46 bingos.

Columbia

In Colombia, psychiatrist Pablo Rodríguez affirms that gambling can destroy a person as much as alcoholism and drug addiction. He recounted many cases in which people lost homes, cars, businesses, as well as family members and friends. Gambling is a bottomless addiction. You can fall more and more and more". Sometimes, in extreme cases, the patient is required to be hospitalized and medicated. In most cases, outpatient treatments work, weekly consultations, meetings with Gamblers Anonymous, affection but also firmness: the family should not pay the debts of a gambler."

Chile

In Chile, a study by the University of Santiago and the Responsible Gaming Corporation says that 2.4% of gamblers in the country are pathological and that 80% of gamblers in Chile are women. In turn, 35.2% of this type of player is in the age group that ranges from 31 to 40 years. Daniel Martínez, psychiatrist and director of Good Responsible Gambling Practices at the CJR, clarifies that men prefer gambling and casinos, related to the desire for competition. In women, on the other hand, there is a greater attraction to slot machines, which increases the percentage of women with pathologies. "They play as a way to disconnect from their emotions. In addition, many have lived depending on the children and upbringing, and when the children leave they run out of activities and find a way to enjoy and entertain themselves in the game. It is a feature of the game to disconnect quickly".

Spain

In Spain, more than half a million people suffer from pathological gambling. Since the Gambling Regulation Law was approved in 2011, the number of casinos and betting houses –especially online- has increased exponentially. This has occurred due to the increase in users, but also to the low cost of maintaining an online casino or betting house, if we compare it with a real one. In addition, the problem of slot machines seems to have receded into the background and online gambling has gained ground and is currently the second most common cause of gambling.

Mexico

Lizbeth García Quevedo, director of the Coordination with Federative Entities (CONADIC), spoke of gambling as a strong addiction in Mexico: "It has very similar behaviors, which is why some experts consider it an addiction because it looks similar in the behaviors, in the origins, some risk factors that can trigger pathological gambling, can also trigger drug use". In Mexico there could be between one and three million people addicted to gambling. "That they be aware of what their children are doing, and that on the other hand they encourage proactive play, healthy play," commented Lizbeth García Quevedo. The document from the Ministry of Health highlights that a study on pathological gambling that analyzed 46 studies carried out in Canada, the United States, Australia, Sweden, Norway, England, Switzerland and Spain, revealed that the prevalence of compulsive gambling is relatively higher among adolescents, which traces the continuity of the problem considering that many pathological gamblers declare that they began their gambling behaviors at an early age.

Panama

In Panama, gambling addiction has grown vertiginously in recent years, becoming a serious problem that affects more and more people from numerous social sectors, especially the poorest and the elderly. Dr. Carlos Smith, specialist in addictions and coordinator of the Center for the Study and Treatment of Addictions, pointed out that at first gambling can be recreational and pleasurable, but later it can become an activity that threatens the integrity of the subject that in the long run term can affect their socio-family and work environment.

Peru

According to EsSalud, the number of patients increases by 33% each year. 5% of people in Peru are affected. Although in Peru there are no accurate data to chart the dimension of the problem, everything indicates that it tends to grow. The National Institute of Mental Health (INSM) estimates that 5% of the population of Metropolitan Lima has complications associated with gambling.

According to figures from the Social Health Security (EsSalud), gambling in Peru grows at a rate of 33% each year. However, the INSM numbers indicate that the percentage may be higher. In the first half of this year, the entity has diagnosed 72 new cases of this disorder.

Uruguay

In Uruguay, the average compulsive gambler is between the ages of 40 and 55, a study reveals. A survey carried out by the Directorate of Casinos, among those who have requested help for compulsive gambling, indicates that 86% of the disease is currently caused by slot machines (or slot machines), followed by a distant 10% for the roulette With 1% are the pools, tombola, 5 de Oro and horse racing, and with 2% card games. Another important fact that the research has revealed is that 65% of gambling patients have a history of growing up with a relative who had gambling problems.

Venezuelan

In Venezuela, in recent years, the rate of compulsive gambling has increased, mostly affecting young people, in sports betting called parley and horse racing. The psychiatrist César Sánchez Bello, assured that he has noticed a notable increase in people sick to gambling who go to psychiatric consultations for addiction, mostly for sports betting, surpassing the people who request attention for addiction to bets and games in casinos. or bingos. He also highlighted the importance of preventing more people from falling into compulsive gambling, which not only affects the patient, but also the family, work, and friendships.

Evaluation

The most common instrument for detecting "probable pathological gambling behaviour" is the South Oaks Gambling Screen (SOGS) developed by Lesieur and Blume (1987) at South Oaks Hospital in New York City. This test is undoubtedly the most cited instrument in the scientific psychological literature. In recent years the use of the SOGS has declined due to growing criticism, among which are those who claim that it overestimates false positives.

The DSM-IV diagnostic criteria are an alternative to SOGS, and focus on the psychological motivations underlying problem gambling, and were developed by the American Psychiatric Association. It consists of ten diagnostic criteria. A test based on the DSM-IV criteria is the National Opinion Research Center DSM Screen for Gambling Problems (NODS). This measurement is used quite frequently. The Canadian Problem Gambling Severity Index (PGSI) is another PGSI assessment instrument that focuses on the harms and consequences associated with gambling.

Treatment of pathological gambling

There are a wide variety of treatments for pathological gambling including counseling, self-help groups, and psychiatric medication. However, none of these treatments is considered to be the most effective, and no medication has been approved by the FDA for the treatment of pathological gambling.

Gamers Anonymous is a commonly used treatment for compulsive gambling. Modeled after Alcoholics Anonymous treatment, it uses a 12-step model that emphasizes a self-help approach.

One approach, cognitive behavioral therapy, has been shown to reduce gambling-related symptoms and urges. This type of therapy focuses on the identification of mental processes related to gambling, cognitive and mood distortions that increase vulnerability to uncontrolled gambling. In addition, this therapy uses skills acquisition techniques aimed at relapse prevention, assertiveness and gambling rejection, problem solving, and reinforcement of activities and interests inconsistent with gambling.

There is evidence that paroxetine is efficient in the treatment of pathological gambling. In addition, for patients suffering from the comorbidity of bipolar disorder and pathological gambling, continuous administration of lithium has been shown to be effective in preliminary trials. The opioid antagonist drug known as malmefene has also proven successful in trials for the treatment of compulsive gambling.

The family also plays an important role in the treatment, first of all it helps to build the patient's motivation, which is not at all predictable. The first phase of the cure is in fact preparatory: an attempt is made to quantify the patient's predisposition to change and to start treatment.

In popular culture

In fiction, Dostoevsky wrote the partly autobiographical work The Gambler. In psychoanalysis, Sigmund Freud wrote an essay based on this work.

In art, Michelangelo Merisi da Caravaggio in 1594 produced his work Card Players.

In the American television series How I Met Your Mother the gambling addiction of one of its main protagonists, Barney Stinson, is commented on numerous times.

In the American television series The Simpsons the character of Marge Simpson suffers from some illnesses, among them the most notable is compulsive gambling that is clearly seen in the chapter «$pringfield (or, How I Learned to Stop Worrying and Love Legalized Gambling)" from season 5, when Mr. Burns opens a casino in Springfield.

In the eighth season of the Spanish television series Cuéntame cómo pasó, the character Antonio Alcántara gets caught up in the game of poker and, as a consequence, comes to owe the approximate amount of 300,000 pesetas of The time. To settle the debt, he will turn to his brother Miguel de él, who will give him money earned from the sale of some land in the town. He finally pays off the debt in chapter 139 but, even so, his relationship with his wife Mercedes is affected.

In the video game Left 4 Dead 2 one of the main characters, Nick, is a gambler who was in custody, arrested for fraud.

In the Chilean children's program 31 minutos, the character Juan Carlos Bodoque is a gambler due to his obsession with betting on horse races, especially his mare Tormenta China which he has never won.

In the American-Canadian children's film Matilda, the character Zinnia Wormwood is a gambler because she is obsessed with gambling and bingo, and thus is an irresponsible housewife.