©2008 The GPPC Initiative 1

Pathological Gambling

An “Invisible” Addiction

©2008 The GPPC Initiative 2

Treatment Issues

Generally the same, particularly with other co-occurring disorders:– Assess– Diagnose– Plan/Initiate Treatment– Evaluate the effectiveness of

method

©2008 The GPPC Initiative 3

Pathological Gambling

• Largely “Invisible”• Largely ignored / overlooked / tolerated

until some precipitating crisis• Personal calamity with collateral damage• High Incidence of Co-Occurring Disorders• High vulnerability at outer edges of the

age spectrum (i.e., Teens and Elders)

©2008 The GPPC Initiative 4

Behavioral Addiction

• Deflection / Displacement• Sub-optimal Stimulation• The gambler becomes

emotionally unavailable to family, friends, and associates

©2008 The GPPC Initiative 5

Diagnostic Spectrum

• Spectrum– Low Risk– At Risk– Problem Gambling– Pathological Gambling

©2008 The GPPC Initiative 6

Types of Gamblers

• Casual Social• Serious Social• Relief & Escape• Compulsive (Problem, Pathological)• Professional• Anti-social Personality

adapted from SAMHSA, 2005

©2008 The GPPC Initiative 7

Risk Factors

• Age at onset of gambling• Gender• Ethnicity• Access• Co-occurring disorders• Family history• Biochemical imbalance

©2008 The GPPC Initiative 8

Direct Risk Factors

• Risk Practices• Risk Cognitions• Risk level can increase based on:

– Number of risk practices and cognitions– The extent of involvement in each

©2008 The GPPC Initiative 9

Thinking Errors (adapted from Ciarrocchi, 2001)

• Negative Winning Expectancy• Independence of Turns• Illusion of Control• Superstition• Recuperating Losses• The “Near-Miss”

©2008 The GPPC Initiative 10

Indirect Risks

• Social Predisposition• Emotional Predisposition• Biological Predisposition• Environmental Conditions

©2008 The GPPC Initiative 11

Health Problems

• Hypertension / Angina• Heart Attack / Stroke• Obesity• Alcoholism / Cirrhosis• Tobacco use

©2008 The GPPC Initiative 12

Co-Morbidity

• Mood Disorders• Substance Abuse

(e.g.,“MethGamblers”)• Anxiety Disorders• Personality Disorders• ADHD• High Risk of Suicidality

©2008 The GPPC Initiative 13

Prevalence / Incidence• 85% of Americans report having

gambled at least once• 60% report having gambled

within the last year• More men than women• More young people than seniors• More African-Americans than

other ethnic groups

©2008 The GPPC Initiative 14

Gambling Population

3% 7%

90%

Problem

At Risk

Ever

Compulsive Gambling affects up to

6 Million Americans

©2008 The GPPC Initiative 15

Nevada vs. The World

• 6.5% General U.S. Population “At Risk”– NV = 9.9%

• 2.5% General U.S. Population “Problem”– NV = 6.4%

©2008 The GPPC Initiative 16

So What’s the Problem?

Gambling Population (% )

2.5

6.56.4

9.9

0

2

4

6

8

10

12

Problem At Risk

U.S.NV

©2008 The GPPC Initiative 17

Addiction as a Maladaptive Behavior

• Addiction is a learned behavior• Most appropriate treatment

approach is to teach skills to prevent relapse

• Cognitive-Behavioral approach can work

©2008 The GPPC Initiative 18

Gambling (Gaming)

Any betting or wagering, for self or others, whether for money or

not, no matter how slight or

insignificant, where the outcome is uncertain or depends upon

chance or “skill”

Gamblers Anonymous

©2008 The GPPC Initiative 19

Substance Abuse

Antisocial Behavior

School/Work Problems

Problem Gambling

Psychological Problems

Poor Health Practices

Interpersonal Problems

Gambling is part of an inter-related set of high risk/problem behaviors

(adapted from Williams & Connolly, 2003)

©2008 The GPPC Initiative 20

Self-Controlled Impulsive

Risk aversive Risk seeking

Stress resilient Stress vulnerable

Strong intellect/skills Weak intellect/skills

Caused by a common set of factors (adapted from Williams & Connolly, 2003)

Abusive/neglectful Nurturing/disciplined

upbringing upbringing

Antisocial parental Prosocial parental

modelling modelling

Deviant peer group Prosocial peer group

Poor schools/ Good schools/teachers teachers

Biological Environmental

©2008 The GPPC Initiative 21

Decisional Balancefor Addictions

If one’s use / behavior creates more

problems than it relieves, seek

assistance