Special Psychiatric Problems Relating to Gambling
Emanuel Moran
Introduction
Gambling is an activity with the following elements:
A contract between two or more people, which is based on a forecast of the outcome of an uncertain event involving random processes.
Property, referred to as the stake, is transferred between those taking part, so that some gain at the expense of others.
The property transfer depends on the outcome or result of the uncertain event, which has been forecast.
Participation is voluntary and not necessarily related to gaining the property, but used to obtain an experience.
Clinical features
Gambling misuse is a behavioural disorder that can usually be recognized by the presence of any of the following features:
Excessive gambling either in terms of the money spent or the time devoted.
Intermittent or continuous preoccupation with gambling and the development of tolerance and craving for it.
Loss of control over gambling and ‘chasing of losses’, despite the realization that damage is resulting.
Disorder affecting the person who is gambling and the family:
financial disturbances, such as debt and shortage;
social disturbances, such as loss of employment and friends, running away from home, eviction, marital problems, divorce, behaviour disorders in the children of the family, criminality and imprisonment;
psychological disturbances, such as depression and attempted suicide.
Classification
In the past, this syndrome has been referred to as compulsive gambling. However, it is not a true obsessive-compulsive state but a heterogeneous group of conditions, characterized by excessive gambling resulting in disturbance for those involved. The term ‘pathological gambling’ is more appropriate, since it is not based on any assumptions regarding the underlying processes.(1)
ICD-10(2) describes pathological gambling as a form of behaviour under ‘habit and impulse disorders’. On the other hand, DSM-IV(3) implies a homogeneous disease entity and provides criteria for its recognition under ‘impulse-control disorders not elsewhere classified’. The ICD-10 approach is preferable since it emphasizes the fact that the condition is a behavioural disorder resulting from faulty habits.
Subcultural gambling arises out of the person’s background, which is one of socially accepted heavy gambling.
Impulsive gambling is characterized by loss of control for varying periods and the tendency to be associated with tolerance, craving, and dependence on the activity.
Neurotic gambling occurs as a response to an emotional problem, particularly in a disturbed relationship in marriage or during adolescence.
Symptomatic gambling occurs in mental illness, usually depression, which is the primary disorder.
Psychopathic gambling is part of the generalized disturbance of behaviour that characterizes antisocial personality disorder.
Diagnosis
For various social reasons, pathological gambling is most easily recognized in men since they tend to patronize those types of gambling that have a high turnover of money so that excess is more likely to become apparent.
Women have tended to gamble on lotteries, bingo, and football pools. These may not involve such large sums of money and excess often presents with disturbances in the social sphere rather than through the accumulation of large debts. However, the greater general acceptance of gambling and the advent of remote gambling via the Internet, television, and mobile devices is changing the situation considerably.
While pathological gambling is seen in all age groups, an increasing number of children and young people are presenting with the condition as a result of gambling on slot/gaming machines. Also, in recent years, remote gambling among children and young people has led to increasing problems. This is in spite of the fact that most jurisdictions treat gambling as an adult activity. Pathological gambling in adulthood frequently has its origins in heavy gambling in childhood and adolescence.
Aetiology and epidemiology
The nature of gambling
The experience of risk provides amusement, thrill, and excitement and is therefore pleasurable. These experiences make gambling attractive and the stake money is used to purchase them, with winnings as an occasional bonus. A few, who gamble professionally, are also able to win money regularly because they have sources of information that reduce the uncertainty, as in betting on horses and dogs. Their gambling is planned and deliberate.
Gambling is usually organized commercially with the odds in favour of the provider. There is therefore an in-built financial disadvantage to those who use the facilities. In slot/gaming machines where the provider is at a distance from the gambling event, this is often not apparent to those who take part.
Commercial gambling involves large sums of money, and has traditionally been confined to licensed premises. Those present have gone there because they have decided to take part in the gambling. However, developments in technology have made it possible to provide gambling facilities on a remote basis via the Internet, television, and mobile devices.
A number of features inherent in the activity of gambling have effects that make it difficult for a person to stop.
Psychological effects
Underlying all gambling activity is operant conditioning with intermittent variable ratio reinforcement.(6) This is a most effective schedule for habit-formation and produces a stable, persistent response. Consequently, the long-term net gain or loss to those who gamble is almost irrelevant to the continuation of the activity. It is most dramatically seen in slot/gaming machines, which consequently are the main source of profit for the gambling industry.
Rapid turnover gambling as in casinos restricts the ability of those who gamble to apply any considered judgement. Inevitably, gambling becomes more impulsive, easily leading to excessive participation.
The assessment of probability of winning (psychological probability) in the gambling situation differs from the mathematical probability. At low probabilities, it is higher than the mathematical probability and at moderate and high probabilities, it is lower. This even occurs in people who are mathematically knowledgeable.
In a gambling situation involving only random processes, where the outcome of successive events is completely independent, there is usually the irrational belief that a string of losses makes a win more likely. This is the negative recency effect, which is also referred to as the’Monte Carlo Fallacy’ since it forms the basis of many spurious gambling systems, especially in roulette. Paradoxically, it is associated with the belief that a string of wins is likely to continue (‘a lucky streak’). Also, a ‘near win’ generally tends to be treated as a prelude to a win. These illogical ways of thinking encourage continuous gambling and are exploited by slot/gaming machines and lottery scratch cards called ‘heart stoppers’.
Large prizes, even at very low probabilities, entice the gambler because of the possibility of winning. The stimulant effect of rollovers in lotteries illustrates this.
Skill in gambling is usually overrated and often implies an unrealistic ability to control the uncertain event that is the subject of the gamble. Thus, in dog and horse race betting, punters tend to place their bets just before ‘the off ’ in the fantasy that this will affect the result.Related posts:
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