Pathological gambling

Causes

Pathological gambling usually begins in early adolescence in men, and between ages 20 and 40 in women.

Pathological gambling often involves repetitive behaviors. People with this problem have a hard time resisting or controlling the impulse to gamble. Although it shares features of obsessive compulsive disorder, pathological gambling is likely a different condition.

In people who develop pathological gambling, occasional gambling leads to a gambling habit. Stressful situations can worsen gambling problems.

Symptoms

People with pathological gambling often feel ashamed and try to avoid letting other people know about their problem. The American Psychiatric Association defines pathological gambling as having five or more of the following symptoms:

• Committing crimes to get money to gamble
• Feeling restless or irritable when trying to cut back or quit gambling
• Gambling to escape problems or feelings of sadness or anxiety
• Gambling larger amounts of money to try to make back past losses
• Losing a job, relationship, education, or career opportunity due to gambling
• Lying about the amount of time or money spent gambling
• Making many unsuccessful attempts to cut back or quit gambling
• Needing to borrow money due to gambling losses
• Needing to gamble larger amounts of money in order to feel excitement
• Spending a lot of time thinking about gambling, such as remembering past experiences or ways to get more money with which to gamble

Exams and Tests

A psychiatric evaluation and history can be used to diagnose pathological gambling. Screening tools such as the Gamblers Anonymous 20 Questions can help with the diagnosis.

Treatment

Treatment for people with pathological gambling begins with recognizing the problem. Pathological gamblers often deny they have a problem or need treatment.

Most people with pathological gambling only get treated when other people pressure them.

Treatment options include:

• Cognitive behavioral therapy (CBT)
• Self-help support groups, such as Gamblers Anonymous. Gamblers Anonymous is a 12-step program similar to Alcoholics Anonymous. Practices used to treat other types of addiction, such as substance abuse and alcohol dependence, can also be helpful in treating pathological gambling.
• A few studies have been done on medications for treating pathological gambling. Early results suggest that antidepressants and opioid antagonists (naltrexone) may help treat the symptoms of pathological gambling. However, it is not yet clear which people will respond to medications.

Outlook (Prognosis)

Like alcohol or drug addiction, pathological gambling is a long-term disorder that tends to get worse without treatment. Even with treatment, it's common to start gambling again (relapse). However, people with pathological gambling can do very well with the right treatment.

Possible Complications

Complications may include:

• Alcohol and drug abuse problems
• Anxiety
• Depression
• Financial, social, and legal problems (including bankruptcy, divorce, job loss, time in prison)
• Heart attacks (from the stress and excitement of gambling)
• Suicide attempts

Getting the right treatment can help prevent many of these problems.

When to Contact a Medical Professional

Call your health care provider or mental health professional if you believe you have symptoms of pathological gambling.

Prevention

Exposure to gambling may increase the risk of developing pathological gambling. Limiting exposure may be helpful for people who are at risk.

Public exposure to gambling, however, continues to increase in the form of lotteries, electronic and Internet gambling, and casinos. Intervention at the earliest signs of pathological gambling may prevent the disorder from getting worse.

Alternative Names

Gambling - compulsive; Compulsive gambling; Addictive gambling

References

Gould CM, Sanders KM. Impulse-control disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 23.

Gamblers anonymous. Twenty questions. Accessed January 11, 2012.

Update Date: 2/13/2012

Updated by: Linda Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.