The Biopsychosocial Consequences of Pathological Gambling

Young adult gambling behaviors and their relationship with the persistence of ADHD. Journal List Dtsch Arztebl Int v. Influence of attention deficit hyperactivity disorder and conduct disorder on opioid dependence severity and psychiatric comorbidity in chronic methadone-maintained patients. Have family members, friends or co-workers expressed concern about your gambling? They were selected from the Interna- difference in attentional bias score between individuals with PG tional Affective Picture System Lang et al. Psychologie Verlags Union; Stress, hormones, and disease.

Biological Consequences of Pathological Gambling

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There was no correlation between PG severity and degree of attentional bias. Theoretical and clinical implications of these results are discussed. Read this article multiple options. No comments yet, be the first to post one! Time course of attentional bias for gambling information in problem gambling.

Attentional bias and disinhibition toward gaming cues are related to problem gaming in male adolescents. Attentional bias in problem gambling: An empirical study of the desire for addictive substances].

Attentional bias and addictive behaviour: Automaticity of cognitive biases in addictive behaviours: Working memory and affective decision-making in addiction: Cannabis dependence, cognitive control and attentional bias for cannabis words.

A neurocognitive comparison of cognitive flexibility and response inhibition in gamblers with varying degrees of clinical severity. Existing User Sign In. New to Read Sign Up. For , the only available data are inpatient data from the German statutory pension insurance scheme. The proportion of women with a first diagnosis of PG was A large gap exists between the number of those affected and the proportion of those who seek treatment.

Of the estimated affected people 4 , in scarcely patients were admitted to addiction services or hospitals for advice or treatment. This corresponds to 2. Men and women differ from one another not only in terms of prevalence rates but also with regard to age distribution. Affected men tend to be younger; the age peak is 30—39 years. Affected women are on average 10 years older e Women tend to have a greater number of secondary diagnoses compared to men.

On the basis of the available data set we cannot comment on the combinations of comorbidities. Mental and behavioral disorders are the commonest comorbidities in pathological gamblers who are receiving treatment e Pathological gamblers in the general population, by contrast, are more prone to displaying personality disorders Table 2.

If the criteria for problematic or pathological gambling were met, in-depth clinical interviews confirming comorbidities by means of M-CIDI and Skid II were conducted. Pathological gambling and affective disorders often go hand in hand. Depression is diagnosed in more than half of pathological gamblers e Some authors postulate that affective disorders are the result of PG 14 , In other studies, no differences were found in the incidence of affective disorders before or after PG had developed e This might be because the types of gamblers listed earlier display depressive symptoms at different times.

Anxiety disorders are also common in PG 14 , These are mostly present even before the PG and increase the risk of developing PG 7. They mostly are panic disorders In addition to fully expressed PSTD, high rates of trauma have been observed.

By comparison, the following rates are reported for the general population: Gambling women receiving treatment had significantly higher trauma rates than men On average, pathological gamblers without PTSD reported four types of trauma with an average of 25 episodes of trauma each. A French cross sectional study that included patients from addiction treatment centers, found 6. All age groups were equally affected.

Abstinence did not prompt a reduction in gambling problems Another study compared gamblers seeking treatment with regard to their smoking behavior. Regular smokers were found to be more beset with gambling problems, among others, than occasional smokers.

They gambled more on weekdays, gambled higher sums, and had a stronger craving for gambling and a reduced feeling of being in control e A US study of patients receiving methadone substitution treatment showed prevalence rates of The pathological gamblers did worse in terms of therapeutic success—that is, relating to their abstinence from cocaine or heroin during therapy and completion of therapy as planned. Alcohol and opiate abuse were of notably minor importance, with 4.

A number of studies have reported high comorbidity rates with personality disorders 19 , with prevalences roughly comparable to those found in psychiatric patients in general e In pathological gamblers who are not undergoing treatment, borderline personality disorders have been observed particularly often Gamblers undergoing treatment have also been found to have high rates of borderline personality disorders as well as histrionic and narcissistic personality disorders e By contrast, a sample of pathological gamblers in Germany who received inpatient treatment often had obsessive-compulsive personality disorder, anxious avoidant personality disorder, or dependent personality disorder Hyperkinetic disorders are also more common in pathological gamblers.

The second group, however, displayed twice the rate of problematic gambling behavior The proportion of pathological gamblers was 5. For the development of compulsive buying, PG, and hypersexuality, a dose-response effect has been observed. The higher the dosage the more common the corresponding disorders For the treatment of PG thus far no clear preference for a particular psychotherapeutic approach has been identified e22 and neither has a therapeutic program been found that meets current standards regarding the proof of effectiveness e23 ; however, in Germany, the following relevant services are available to clinical practitioners.

Currently there are a total of 25 hospitals that accept patients with a primary diagnosis of PG. Another 30 hospitals accept patients with PG as a secondary diagnosis. The remaining federal states each have 1—2 of such hospitals, with the exception of Hamburg Winter S et al.: Poster presentation at the 12 th interdisciplinary conference on addiction medicine, Munich, July A suitable rehabilitation hospital can be found more easily by using LSG-Klinikexplorer www.

Increasingly, advice centers also provide the option of outpatient rehabilitation. In Bavaria, for example, 14 advice centers have gained the required recognition status. This is reflected in the trends in the use of outpatient services: From to , the numbers of those seeking treatment have more than doubled e The internet also provides support services, such as self-help forums e.

In view of the gambling options currently on offer, expansion and extension of support services are urgently needed, in order to raise awareness of problems and enable early intervention. Ideally, this would also mean that more of those affected could receive adequate advice and treatment earlier on. Conflict of interest statement. Ministries and subordinate authorities in the Free State of Bavaria are active as operators or grant licenses for gambling.

National Center for Biotechnology Information , U. Journal List Dtsch Arztebl Int v. Published online Mar 9. Beate Erbas , Dr. Received Aug 1; Accepted Nov 7. See the reply " Correspondence letter to the editor: See the reply " Correspondence reply: This article has been cited by other articles in PMC. Abstract Background The number of pathological gamblers seeking treatment has risen continuously till the present, and the trend shows no sign of reversal.

Methods This article is based on an analysis of secondary data obtained from the German Statutory Pension Insurance Scheme and the Federal Statistical Office and on a selective review of the literature on comorbidities and available interventions. Results The rate of inpatient treatment for pathological gambling tripled from to Conclusion As with alcoholics, only a small fraction of pathological gamblers receives the appropriate support and treatment.

Legal framework In Germany, gambling is prohibited as a demerit good according to sections ff of the penal code. Diagnostic evaluation and screening instruments Pathological gambling PG is currently categorized as a habit and impulse disorder. Is preoccupied with gambling. Has jeopardized or lost an important relationship, job, or educational or career opportunity because of gambling.

Relies on others to provide money to relieve a desperate financial situation caused by gambling. These episodes do not have a profitable outcome for the person, but are continued despite personal distress and interference with personal functioning in daily living. The person describes an intense urge to gamble which is difficult to control, and reports that he or she is unable to stop gambling by an effort of will. The person is preoccupied with thoughts or mental images of the act of gambling or the circumstances surrounding the act.

Open in a separate window. During the past 12 months, have you become restless, irritable, or anxious when trying to stop and or cut down on gambling? During the past 12 months, have you tried to keep your family or friends from knowing how much you gambled?

During the past 12 months, did you have such financial trouble as a result of gambling that you had to get help with living expenses from family, friends, or welfare? Types of gamblers and their characteristics In addition to the diagnostic evaluation, several characteristics are relevant for the practicing physician.

Box 2 Types of gambler according to Blaszczynski and Nower 7. Behaviorally conditioned problem gamblers: This group displays only minimal levels of psychopathology.

The gamblers are mostly motivated to start treatment. Often, minimal interventions and counselling are sufficient. Emotionally vulnerable problem gamblers: Therefore, change is harder to achieve. The underlying vulnerability needs to be addressed and treated in the context of therapy. Antisocial impulsivist problem gamblers: In contrast to the emotionally vulnerable problem gamblers, this group has a higher prevalence of antisocial personality disorders, attention deficit disorders, and a high degree of impulsivity.

It is difficult to motivate such gamblers to start treatment; they show low compliance and have high dropout rates. Furthermore, they respond poorly to any form of intervention. Prevalence Six studies with prevalence estimates of PG currently exist for Germany 4 , 9 , 11 , 12 , e8 , e Inpatient services for medical rehabilitation or other services for adult patients with a diagnosis of pathological gambling ICD F Patient characteristics Men and women differ from one another not only in terms of prevalence rates but also with regard to age distribution.

Comorbidities Mental and behavioral disorders are the commonest comorbidities in pathological gamblers who are receiving treatment e Table 2 Lifetime prevalence of comorbid mental disorders in PG, in a comparison between the general population e11 and a clinical sample Affective disorders Pathological gambling and affective disorders often go hand in hand.

Anxiety disorders Anxiety disorders are also common in PG 14 , Posttraumatic stress disorder and trauma


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